Development and Validation of Nomogram Predicting Survival in Resectable Gallbladder Cancer

BACKGROUND: Gallbladder cancers (GBCs) are aggressive tumors with limited improvement in outcomes over decades. Accurate prediction of survival is crucial for tailored treatment and improved outcomes. OBJECTIVE: To develop a nomogram predicting overall survival (OS) in resectable GBCs. METHODS: A retrospective analysis of 1045 patients of resected gallbladder cancer between January 2010 to December 2022 was done. A predictive nomogram was built and was internally validated. RESULTS: The nomogram included age, original T stage, original N stage, and lympho-vascular/perineural invasion, CA 19.9, incidental versus non-incidental GBC, and grade. The Harrell's concordance index for the nomogram was 0.677. The area under the ROC curves for 1-, 3-, and 5-year OS were 72.12, 72.64, and 71.15 respectively. Patients were stratified into low-risk and high-risk groups based on a threshold score of 22.48, with significantly different median OS (not reached vs. 31.4 months, p < 0.001). CONCLUSIONS: The developed nomogram demonstrates good discriminative capacity and risk stratification in patients undergoing surgery for GBC and may be utilized for better selection and application of adjuvant treatment strategies, potentially improving outcomes.