Prognostic factors in patients with gallbladder adenocarcinoma identified using competing-risks analysis

Abstract

A competing-risks model was developed in this study to identify the significant prognostic factors and evaluate the cumulative incidence of cause-specific death in gallbladder adenocarcinoma (GBAC), with the aim of providing guidance on effective clinical treatments. All patients with GBAC in the Surveillance, Epidemiology, and End Results (SEER) database during 1973 to 2015 were identified. The potential prognostic factors were identified using competing-risks analyses implemented using the R and SAS statistical software packages. We calculated the cumulative incidence function (CIF) for cause-specific death and death from other causes at each time point. The Fine-Gray proportional-subdistribution-hazards model was then applied in univariate and multivariate analyses to test the differences in CIF between different groups and identify independent prognostic factors. This study included 3836 eligible patients who had been enrolled from 2004 to 2015 in the SEER database. The univariate analysis indicated that age, race, AJCC stage, RS, tumor size, SEER historic stage, grade, surgery, radiotherapy, chemotherapy and adjuvant therapy (RCT, SRT, SCT and SRCT) were significant factors affecting the probability of death due to GBAC. The multivariate analysis indicated that age, race, AJCC stage, RS status, tumor size, grade and SRT were independent prognostic factors affecting GBAC cancer-specific death. A nomogram model was constructed based on multivariate models for death related to GBAC. We have constructed the first competing-risks nomogram for GBAC. The model was found to perform well. This novel validated prognostic model may facilitate the choosing of beneficial treatment strategies and help when predicting survival.

Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors

“…The recently published BILCAP trial, of which 17.7% of the total trial population had GBC, demonstrated that adjuvant chemotherapy improves survival in surgically resected patients by 17 months [ 22 ]. The beneficial effect of radiation on the survival of GBC patients seen in our data is supported by some single institution studies [ 36 , 37 , 38 , 39 , 40 ], while previous SEER studies have reported conflicting results [ 34 , 41 ]. This is of clinical relevance and warrants further investigation regarding the role of radiation therapy in the management of GBC.…”

“…Multidisciplinary approaches to patient care, adherence to guidelines, earlier adoption of adjuvant chemotherapy, and disease-specific subspecialist expertise may potentially explain the observed differences, but further research is warranted. Regarding race, previous studies have shown that black patients are at increased risk of death compared with white patients [ 34 ], and black and Hispanic patients are less likely to receive curative intent surgery with adequate lymph node dissection compared with white patients [ 35 ]. In our study, black patients with T2 stage disease were at increased risk of death, and these findings should be further investigated to elucidate any association or confounding factors related to treatment disparities between races.…”

Clinical efficacy of adjuvant treatments for patients with resected biliary tract cancer: a systematic review and network meta-analysis

“…Nineteen studies comprising a total of 5595 patients who received one of the following four different treatments after radical resection—ACT, ART, ACRT and surgical resection alone (observation group)—were included in our analysis. It is worth noting that 34 studies11 41–73 were excluded because of unbalanced or unclear baselines. Of the included patients, 2774 patients received adjuvant treatments following curative-intent resection, and 2821 patients underwent curative-intent resection without adjuvant treatments.…”

Evolving Paradigms in the Systemic Treatment of Advanced Gallbladder Cancer: Updates in Year 2022

“…Gallbladder cancer (GBC) is a rare but deadly malignancy, with an estimated 5-year survival rate of 2% in metastatic disease. Prognosis is particularly poor in older patients and racial minorities [ 1 ]. Worldwide, the incidence of GBC varies significantly based on geographic location.…”