Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer
Using US Medicare records from 1,137 older patients, a calculator was built to estimate who might gain from radiotherapy with chemotherapy after gallbladder cancer surgery; it points to those whose tumour had reached the muscle layer or the nodes.
Overview
SEER-Medicare analysis of patients with resected gallbladder cancer diagnosed 1995 to 2005 (1,137 met inclusion criteria), with propensity score weighting to balance covariates between those who did and did not receive adjuvant chemotherapy or chemoradiotherapy. Several parametric survival models were compared; a lognormal model performed best and was built into a web-based nomogram for individualised survival estimates. The model predicts that certain subsets with at least T2 or N1 disease gain a survival benefit from adjuvant chemoradiotherapy, with the size of benefit varying between individuals.
- 1,137 SEER-Medicare patients with resected gallbladder cancer, 1995 to 2005.
- Model predicts adjuvant chemoradiotherapy benefit for subsets with at least T2 or N1 disease.
The observational basis, with SWOG S0809, for offering chemoradiation after node-positive or margin-positive resection in the United States. UK practice rarely does so; a randomised trial has never been run.
- Registry data on patients over 65 with treatment selection bias that weighting cannot fully remove.
- Pre-dates modern chemotherapy and staging.
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