Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer.
OBJECTIVE
The benefit of adjuvant radiotherapy (RT) for gallbladder cancer remains controversial because most published data are from small, single-institution studies. The purpose of this study was to construct a survival prediction model to enable individualized predictions of the net survival benefit of adjuvant RT for gallbladder cancer patients based on specific tumor and patient characteristics.


METHODS
A multivariate Cox proportional hazards model was constructed using data from 4,180 patients with resected gallbladder cancer diagnosed from 1988 to 2003 from the Surveillance, Epidemiology, and End Results database. Patient and tumor characteristics were included as covariates and assessed for association with overall survival (OS) with and without adjuvant RT. The model was internally validated for discrimination and calibration using bootstrap resampling.


RESULTS
On multivariate regression analysis, the model showed that age, sex, papillary histology, stage, and adjuvant RT were significant predictors of OS. The survival prediction model demonstrated good calibration and discrimination, with a bootstrap-corrected concordance index of 0.71. The model predicts that adjuvant RT provides a survival benefit in node-positive or >or= T2 disease. A nomogram and a browser-based software tool were built from the model that can calculate individualized estimates of predicted net survival gain attributable to adjuvant RT, given specific input parameters.


CONCLUSIONS
In the absence of large, prospective, randomized, clinical trial data, a regression model can be used to make individualized predictions of the expected survival improvement from the addition of adjuvant RT after gallbladder cancer resection.
Wang
Samuel J
SJ
Department of Radiation Medicine, KPV4, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA. wangsa@ohsu.edu
Fuller
C David
CD
Kim
Jong-Sung
JS
Sittig
Dean F
DF
Thomas
Charles R
CR
Ravdin
Peter M
PM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003658:Decision Making, Computer-Assisted; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009367:Neoplasm Staging; D049451:Nomograms; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D018426:SEER Program; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States