Integrated analysis of serum lipid profile for predicting clinical outcomes of patients with malignant biliary tumor
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RESEARCH ARTICLE
Open Access
Integrated analysis of serum lipid profile for predicting clinical outcomes of patients with malignant biliary tumor Lejia Sun1†, Xin Ji2†, Dongyue Wang2†, Ai Guan2, Yao Xiao1, Haifeng Xu1, Shunda Du1, Yiyao Xu1, Haitao Zhao1, Xin Lu1, Xinting Sang1, Shouxian Zhong1, Huayu Yang1* and Yilei Mao1*
Abstract Background: Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear. Thus we aim to assess and compare prognosis values of different serum lipids, and construct a novel prognostic nomogram based on serum lipids. Methods: Patients with a confirmed diagnosis of MBT at our institute from 2003 to 2017 were retrospectively reviewed. Prognosis-related factors were identified via univariate and multivariate Cox regression analyses. Then the novel prognostic nomogram and a 3-tier staging system were constructed based on these factors and further compared to the TNM staging system. Results: A total of 368 patients were included in this study. Seven optimal survival-related factors—TC/HDL > 10.08, apolipoprotein B > 0.9 g/L, lipoprotein> 72 mg/L, lymph node metastasis, radical cure, CA199 > 37 U/mL, and tumor differentiation —were included to construct the prognostic nomogram. The C-indexes in training and validation sets were 0.738 and 0.721, respectively. Besides, ROC curves, calibration plots, and decision curve analysis all suggested favorable discrimination and predictive ability. The nomogram also performed better predictive ability than the TNM system and nomogram without lipid parameters. And the staging system based on nomogram also presented better discriminative ability than TNM system (P < 0.001). Conclusions: The promising prognostic nomogram based on lipid parameters provided an intuitive method for performing survival prediction and facilitating individualized treatment and was a great complement to the TNM staging system in predicting overall survival. Keywords: Serum lipid, Prognosis, Biomarker, Nomogram, Malignant biliary tumor
* Correspondence: [email protected]; [email protected] † Lejia Sun, Xin Ji and Dongyue Wang contributed equally to this work. 1 Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing 100730, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative
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