Prognostic value of preoperative serum tumor markers in gallbladder cancer.

Objective: To investigate the clinical factors related to poor prognosis of gallbladder cancer (GBC) patients, and to develop a prognostic model which may provide the guidance for clinical decision-making.

Methods: The clinical and pathological data of 136 patients with GBC admitted and treated in the Hunan Provincial People's Hospital from January 2018 to July 2023 were retrospectively analyzed. All patients were followed up periodically by telephone, with the final follow-up on July 15, 2024. The Kaplan-Meier method was employed for univariate survival analysis. The log-rank test was utilized to assess differences in survival curves. A Cox regression model was applied for multivariate analysis to identify independent prognostic factors for GBC. Independent prognostic factors identified through Cox modeling were integrated into a nomogram. Finally, receiver operating characteristic (ROC) curves and calibration curves were plotted for 1-, 2-, and 3-year survival predictions.

Results: GBC patients were predominantly female and elderly. GBC patients with diabetes, jaundice and Child-Pugh B/C classification of liver function had poorer overall survival (OS) outcomes. Elevated serum tumor biomarkers CA19-9, CA125, CEA, CA724 and CYFRA21-1 were associated with unfavorable OS in GBC patients. Additionally, the differentiation grade, Lymphovascular invasion (LVI), perineural invasion (PNI), clinical staging and TNM staging were also related to the OS of GBC patients. For GBC patients who underwent surgical treatment, OS was significantly improved, with the most notable improvement observed in those who received radical surgery. GBC patients treated with chemotherapy-based drug treatment experienced an improvement in OS. Multivariate Cox regression analysis revealed that diabetes, elevated CA125, and advanced TNM stage were independent risk factors for GBC prognosis, while chemo-immunotherapy/targeted therapy was an independent protective factor.

Conclusion: Diabetes, elevated CA125 levels, TNM stage, and chemo-immunotherapy/targeted therapy are independent prognostic factors for GBC patients, which could be used to develop a nomogram model and contribute to provide the guidance for clinical treatment.