A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study
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RESEARCH ARTICLE
Open Access
A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study Yingnan Yang, Zhuolong Tu, Huajie Cai, Bingren Hu, Chentao Ye and Jinfu Tu*
Abstract Background: Existing imaging techniques have a low ability to detect lymph node metastasis (LNM) of gallbladder cancer (GBC). Gallbladder removal by laparoscopic cholecystectomy can provide pathological information regarding the tumor itself for incidental gallbladder cancer (IGBC). The purpose of this study was to identify the risk factors associated with LNM of IGBC and to establish a nomogram to improve the ability to predict the risk of LNM for IGBC. Methods: A total of 796 patients diagnosed with stage T1/2 GBC between 2004 and 2015 who underwent surgery and lymph node evaluation were enrolled in this study. We randomly divided the dataset into a training set (70%) and a validation set (30%). A logistic regression model was used to construct the nomogram in the training set and then was verified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration. Results: The rates of LNM in T1a, T1b and T2 patients were 7, 11.1 and 44.3%, respectively. Tumor diameter, T stage, and tumor differentiation were independent factors affecting LNM. The C-index and AUC of the training set were 0.718 (95% CI, 0.676–0.760) and 0.702 (95% CI, 0.659–0.702), respectively, demonstrating good prediction performance. The calibration curves showed perfect agreement between the nomogram predictions and actual observations. Decision curve analysis showed that the LNM nomogram was clinically useful when the risk was decided at a possibility threshold of 2–63%. The Cindex and AUC of the validation set were 0.73 (95% CI: 0.665–0.795) and 0.692 (95% CI: 0.625–0.759), respectively. Conclusion: The nomogram established in this study has good prediction ability. For patients with IGBC requiring reresection, the model can effectively predict the risk of LNM and make up for the inaccuracy of imaging. Keywords: SEER, Incidental gallbladder cancer, Nomogram, Lymph node metastasis, Predict
Backgroud Gallbladder cancer (GBC) is a rare malignancy. Its annual incidence rate is 2.2 per 100,000 [1]. GBC has no obvious characteristic manifestations at its early stage, so it is difficult to identify early. However, it is highly invasive [2]. Most GBC patients are at an advanced stage once confirmed and lose the opportunity for surgical treatment [3]. Fortunately, with the development of laparoscopy, an increasing number of * Correspondence: [email protected] Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
GBCs may be confirmed at the early stage through laparoscopic cholecystectomy (LC) so that early R0 resection may be performed; thus, progression of the disease may be avoided, and the overall survival rate may be improved [4, 5]. More than 50% of GBCs are diagnosed by
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