Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma
Le-Jia Sun, Ai Guan, Wei-Yu Xu, Mei-Xi Liu, Huan-Huan Yin, Bao Jin, Gang Xu, Fei-Hu Xie, Hai-Feng Xu, Shun-Da Du, Yi-Yao Xu, Hai-Tao Zhao, Xin Lu, Xin-Ting Sang, Hua-Yu Yang, Yi-Lei Mao
Le-Jia Sun, Bao Jin, Gang Xu, Fei-Hu Xie, Hai-Feng Xu, Shun-Da Du, Yi-Yao Xu, Hai-Tao Zhao, Xin Lu, Xin-Ting Sang, Hua-Yu Yang, Yi-Lei Mao, Department of Liver Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Ai Guan, Mei-Xi Liu, Huan-Huan Yin, Department of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Wei-Yu Xu, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100730, China
Author contributions: Sun LJ, Guan A, and Xu WY contributed equally to this work; Sun LJ, Guan A, Xu WY, and Mao YL designed and coordinated the study; Yin HH, Liu MX, Jin B, Xu G, Xie FH, Xu HF, Du SD, Xu YY, Zhao HT, Lu X, Sang XT, and Yang HY performed the experiments; Guan A and Mao YL acquired and analyzed the data; Sun LJ and Guan A contributed to writing the original draft.
Supported by CAMS Innovation Fund for Medical Sciences, No. 2016-I2M-1-001; and Tsinghua University-Peking Union Medical College Hospital Cooperation Project, No. PTQH201904552.
Institutional review board statement: All procedures were approved by the Medical Ethics Committee of Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College and were conducted in accordance with the Helsinki Declaration of 1965 and later versions.
Informed consent statement: The requirement for informed consent was waived because of the retrospective nature of this study.
Conflict-of-interest statement: All the authors have declared no conflicts of interest related to this manuscript.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi-Lei Mao, MD, PhD, Doctor, Professor, Department of Liver Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Shuaifu Street, Beijing 100730, China. pumch-liver@hotmail.com
Received: May 2, 2020
Peer-review started: May 2, 2020
First decision: May 26, 2020
Revised: May 30, 2020
Accepted: August 4, 2020
Article in press: August 4, 2020
Published online: September 15, 2020
ARTICLE HIGHLIGHTS
Research background
Gallbladder carcinoma (GBC) carries a poor prognosis and requires a prediction method. Gamma-glutamyl transferase–to–platelet ratio (GPR) is a recently-reported cancer prognostic factor. Although the mechanism of GPR’s relationship with poor cancer prognosis remains unclear, studies have demonstrated the clinical effect of both GGT and platelet count on GBC and related gallbladder diseases.
Research motivation
We aimed to elucidate the prognostic value of GPR and to improve the current prognostic system for GBC patients
Research objectives
We aimed to assess the prognostic value of GPR and to design a prognostic nomogram for GBC.
Research methods
The analysis involved 130 GBC patients who underwent surgery at Peking Union Medical College Hospital from December 2003 to April 2017. Patients were stratified into a high- or low-GPR group. The predictive ability of GPR was evaluated by Kaplan–Meier analysis and a Cox regression model. We developed a nomogram based on GPR, which we verified using calibration curves. The nomogram and other prognosis prediction models were compared using time-dependent receiver operating characteristic curves and the C-index.
Research results
Patients in the high-GPR group had a higher risk of jaundice, were older, and had higher carbohydrate antigen 19-9 levels and worse postoperative outcomes. Univariate analysis revealed that GPR, age, body mass index, tumor–node–metastasis (TNM) stage, jaundice, cancer cell differentiation degree, and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were related to overall survival (OS). Multivariate analysis confirmed that GPR, body mass index, age, and TNM stage were independent predictors of poor OS. Calibration curves were highly consistent with actual observations. Comparisons of time-dependent receiver operating characteristic curves and the C-index showed advantages for the nomogram over TNM staging.
Research conclusions
GPR is an independent predictor of GBC prognosis, and nomogram-integrated GPR is a promising predictive model for OS in GBC.
Research perspectives
First, multicenter research based on our nomogram model is required to confirm the prediction outcomes of our model. Second, further research should expand the study population and confirm the prediction value of GPR. Finally, further research should also broaden the database and combine more clinical data.
