Establishment of a Pretreatment Nomogram to Predict the 6-Month Mortality Rate of Patients with Advanced Biliary Tract Cancers Undergoing Gemcitabine-Based Chemotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients and Data Collection
2.2. Statistical Analysis
2.3. Nomogram Creation
2.4. Performance of the Nomogram
2.5. Statistical Software
3. Results
3.1. Clinicopathological Characteristics of the Included Patients
3.2. Independent Prognostic Factors in the Entire Cohort
3.3. Prognostic Nomogram for 6-Month Mortality Estimation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | N (%) or Median (IQR) |
---|---|
Age (years) | 63.0 (13.0) |
Gender | |
Male | 102 (50.5) |
Female | 100 (49.5) |
ICD-10 cancer site | |
C22.1-ICCA | 120 (59.4) |
C23/C24.9-GB/others | 37 (18.36) |
C24.0-ECCA | 38 (18.8) |
C24.1-Ampullary | 7 (3.5) |
Performance score | |
0 | 31 (15.3) |
1 | 142 (70.3) |
2 | 25 (12.4) |
3 | 4 (2.0) |
NLR | 3.9 (4.0) |
MLR | 0.4 (0.3) |
PLR | 157.4 (119.4) |
Albumin (g/dL) | 3.7 (0.9) |
ALT (U/L) | 31.0 (41.0) |
Bilirubin (mg/dL) | 0.8 (1.0) |
ALP (U/L) | 169.0 (170.8) |
Creatinine (mg/dL) | 0.6 (0.4) |
CA199 (U/mL) | 260.7 (1384.6) |
CEA (ng/mL) | 3.0 (9.7) |
Biliary drainage | |
None | 132 (65.3) |
Internal stenting | 13 (6.4) |
PTCD | 51 (25.2) |
Both | 6 (3.0) |
Tumor involvement | |
Primary tumor | |
No | 15 (7.4) |
Yes | 187 (92.6) |
Regional lymphadenopathy | |
No | 74 (36.6) |
Yes | 128 (63.4) |
Lung | |
No | 170 (84.2) |
Yes | 32 (15.8) |
Bone | |
No | 186 (92.1) |
Yes | 16 (7.9) |
Liver | |
No | 120 (59.4) |
Yes | 82 (40.6) |
Peritoneum | |
No | 168 (83.2) |
Yes | 34 (16.8) |
Distant lymphadenopathy | |
No | 175 (86.6) |
Yes | 27 (13.4) |
Response | |
CR/PR | 24 (11.9) |
SD | 25 (12.4) |
PD | 84 (41.6) |
NA | 69 (34.2) |
Predictor Variables | 6-Month Mortality | p-Value | Odds Ratio | 95% CI of Odds Ratio | p-Value | |
---|---|---|---|---|---|---|
Yes (n = 81) | No (n = 121) | |||||
Age (years) | ||||||
≤65 | 47 (58.0) | 72 (59.5) | 0.834 | |||
>65 | 34 (42.0) | 49 (40.5) | ||||
Gender | 0.009 | |||||
Male | 50 (61.7) | 52 (43.0) | 2.40 | 1.21–4.76 | 0.012 | |
Female | 31 (38.3) | 69 (57.0) | 1 | |||
ICD-10 cancer site | 0.012 | |||||
C22.1-ICCA | 51 (63.0) | 69 (57.0) | 1 | |||
C23/C24.9-GB/others | 20 (24.7) | 17 (14.0) | 2.35 | 0.97–5.70 | 0.058 | |
C24.0-ECCA | 10 (12.3) | 28 (23.1) | 0.72 | 0.29–1.80 | 0.479 | |
C24.1-Ampullary | 0 | 7 (5.8) | 0.07 | 0.01–1.40 | 0.081 | |
Performance score | 0.009 | |||||
0/1 | 63 (77.8) | 110 (90.9) | 1 | |||
2/3 | 18 (22.2) | 11 (9.1) | 2.28 | 0.89–5.85 | 0.087 | |
NLR | <0.0001 | |||||
<3.95 | 24 (29.6) | 80 (66.1) | 1 | |||
≥3.95 | 57 (70.4) | 41 (33.9) | 1.27 | 0.49–3.30 | 0.619 | |
MLR | <0.0001 | |||||
<0.39 | 20 (24.7) | 86 (71.1) | 1 | |||
≥0.39 | 61 (75.3) | 35 (28.9) | 4.50 | 1.74–11.69 | 0.002 | |
PLR | 0.005 | |||||
<147.2 | 24 (29.6) | 60 (49.6) | 1 | |||
≥147.2 | 57 (70.4) | 61 (50.4) | 0.99 | 0.45–2.19 | 0.975 | |
Albumin (g/dL) * | 0.002 | |||||
<3.5 | 38 (51.4) | 30 (28.3) | ||||
≥3.5 | 36 (48.6) | 76 (71.7) | ||||
ALT (U/L) | 0.060 | |||||
≤36 | 54 (66.7) | 64 (53.3) | ||||
>36 | 27 (33.3) | 56 (46.7) | ||||
Bilirubin (mg/dL) | 0.209 | |||||
≤1.3 | 54 (67.5) | 90 (75.6) | ||||
>1.3 | 26 (32.5) | 29 (24.4) | ||||
ALP (U/L) | 0.021 | |||||
≤94 | 11 (13.6) | 33 (27.3) | 1 | |||
>94 | 70 (86.4) | 88 (72.7) | 2.65 | 1.11–6.33 | 0.029 | |
Creatinine (mg/dL) | 0.062 | |||||
≤1.27 | 75 (92.6) | 119 (98.3) | ||||
>1.27 | 6 (7.4) | 2 (1.7) | ||||
CA199 (U/mL) | 0.858 | |||||
<37 | 21 (26.6) | 29 (25.4) | ||||
≥37 | 58 (73.4) | 85 (74.6) | ||||
CEA (ng/mL) | 0.638 | |||||
≤5 | 49 (60.5) | 74 (63.8) | ||||
>5 | 32 (39.5) | 42 (36.2) | ||||
Biliary drainage | 0.589 | |||||
None | 51 (63.0) | 81 (66.9) | ||||
Internal stenting | 5 (6.2) | 8 (6.6) | ||||
PTCD | 21 (25.9) | 30 (24.8) | ||||
Both | 4 (4.9) | 2 (1.7) | ||||
Tumor involvement | ||||||
Primary tumor | 0.099 | |||||
No | 3 (3.7) | 12 (9.9) | ||||
Yes | 78 (96.3) | 109 (90.1) | ||||
Regional lymphadenopathy | 0.841 | |||||
No | 29 (35.8) | 45 (37.2) | ||||
Yes | 52 (64.2) | 76 (62.8) | ||||
Lung | 0.394 | |||||
No | 66 (81.5) | 104 (86.0) | ||||
Yes | 15 (18.5) | 17 (14.0) | ||||
Bone | 0.170 | |||||
No | 72 (88.9) | 114 (94.2) | ||||
Yes | 9 (11.1) | 7 (5.8) | ||||
Liver | 0.008 | |||||
No | 39 (48.1) | 81 (66.9) | 1 | |||
Yes | 42 (51.9) | 40 (33.1) | 2.38 | 1.17–4.83 | 0.017 | |
Peritoneum | 0.094 | |||||
No | 63 (77.8) | 105 (86.8) | ||||
Yes | 18 (22.2) | 16 (13.2) | ||||
Distant lymphadenopathy | 0.621 | |||||
No | 69 (85.2) | 106 (87.6) | ||||
Yes | 12 (14.8) | 15 (12.4) | ||||
Regimen | 0.334 | |||||
G alone | 20 (24.7) | 23 (19.0) | ||||
G-based doublet C/T | 61 (75.3) | 98 (81.0) | ||||
Response | <0.0001 | |||||
CR/RR | 2 (2.5) | 22 (18.2) | ||||
SD | 9 (11.1) | 60 (49.6) | ||||
PD | 46 (56.8) | 38 (31.4) | ||||
NA | 24 (29.6) | 1 (0.8) |
Predictor Variables | Hazard Ratio (HR) | 95% CI for HR | p-Value | |
---|---|---|---|---|
Lower | Upper | |||
Gender | ||||
Male | 1.935 | 1.001 | 3.739 | 0.049 |
Female | Reference | |||
MLR | ||||
<0.39 | Reference | |||
≥0.39 | 6.620 | 3.421 | 12.811 | <0.0001 |
ALP (U/L) | ||||
≤94 | Reference | |||
>94 | 2.322 | 0.995 | 5.421 | 0.051 |
Liver metastasis | ||||
No | Reference | |||
Yes | 2.251 | 1.153 | 4.396 | 0.017 |
Predictor Variables | Points Assigned |
---|---|
Gender | |
Male | 35 |
Female | 0 |
MLR | |
<0.39 | 0 |
≥0.39 | 100 |
ALP (U/L) | |
≤94 | 0 |
>94 | 45 |
Liver metastasis | |
No | 0 |
Yes | 43 |
Total score | Probability of 6-month mortality (%) |
30 | 0.10 |
73 | 0.20 |
101 | 0.30 |
125 | 0.40 |
146 | 0.50 |
167 | 0.60 |
191 | 0.70 |
219 | 0.80 |
Model | Overall Performance Measure | Discrimination | Calibration |
---|---|---|---|
Nagelkerke R2 | C Statistic | Hosmer–Lemeshow Test | |
Risk prediction model | 0.205 | 0.791 | 0.410 |
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Wu, C.-E.; Huang, W.-K.; Chou, W.-C.; Hsieh, C.-H.; Chang, J.W.-C.; Lin, C.-Y.; Yeh, C.-N.; Chen, J.-S. Establishment of a Pretreatment Nomogram to Predict the 6-Month Mortality Rate of Patients with Advanced Biliary Tract Cancers Undergoing Gemcitabine-Based Chemotherapy. Cancers 2021, 13, 3139. https://doi.org/10.3390/cancers13133139
Wu C-E, Huang W-K, Chou W-C, Hsieh C-H, Chang JW-C, Lin C-Y, Yeh C-N, Chen J-S. Establishment of a Pretreatment Nomogram to Predict the 6-Month Mortality Rate of Patients with Advanced Biliary Tract Cancers Undergoing Gemcitabine-Based Chemotherapy. Cancers. 2021; 13(13):3139. https://doi.org/10.3390/cancers13133139
Chicago/Turabian StyleWu, Chiao-En, Wen-Kuan Huang, Wen-Chi Chou, Chia-Hsun Hsieh, John Wen-Cheng Chang, Cheng-Yu Lin, Chun-Nan Yeh, and Jen-Shi Chen. 2021. "Establishment of a Pretreatment Nomogram to Predict the 6-Month Mortality Rate of Patients with Advanced Biliary Tract Cancers Undergoing Gemcitabine-Based Chemotherapy" Cancers 13, no. 13: 3139. https://doi.org/10.3390/cancers13133139