γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

Table 1 Clinicopathological characteristics of the 130 patients with gallbladder adenocarcinoma in this study

Characteristic	mean ± SD or median (IQR) or n (%)
Age, yr	63.23 ± 1.20
Gender
Male	76 (58)
Female	54 (42)
BMI, kg/m2	23.97 ± 0.38
Jaundice
No	111 (85)
Yes	19 (15)
Gallbladder stone
No	68 (52)
Yes	62 (48)
Liver disease
No	118 (91)
Yes	12 (9)
Differentiation stage of cancer cell
Low	21 (16)
Low-medium	26 (20)
Medium	32 (25)
Medium-high	19 (15)
High	18 (14)
TNM stage
I	16 (12)
II	11 (8)
III	83 (65)
IV	20 (15)
CEA, ng/mL	2.59 (1.62-5.50)
CA 19-9, U/mL	47.50 (13.03-220.85)
Maximal tumor diameter, cm	2.70 (1.50-4.55)
GPR	0.17 (0.09-0.44)
Postoperative complications
No	101 (78)
Yes	29 (22)
HOD, D	15 (10-20)
OS, Mo	18 (6-34)

BMI: Body mass index; TNM: Tumor–node–metastasis; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; GPR: Gamma-glutamyl transferase–to–platelet ratio; HOD: Hospitalization days; OS: Overall survival; SD: Standard deviation; IQR: Interquartile range.

Table 2 Clinical characteristics of the patients according to gamma-glutamyl transferase–to–platelet ratio

Patients	GPR ≤ 0.365, n (%)	GPR > 0.365, n (%)	P value
Age, yr			0.661
≤ 60	34 (37)	13 (33)
> 60	57 (63)	26 (67)
Gender			0.484
Male	55 (60)	21 (54)
Female	36 (40)	18 (46)
Jaundice			< 0.001
No	87 (96)	24 (62)
Yes	4 (4)	15 (38)
Gallbladder stone			0.319
No	45 (49)	23 (59)
Yes	46 (51)	16 (41)
Liver disease			0.509
No	81 (89)	37 (95)
Yes	10 (11)	2 (5)
Differentiation stage of cancer cells			0.640
Low	14 (18)	7 (23)
Low-medium	18 (23)	7 (23)
Medium	18 (23)	8 (26)
Medium-high	16 (21)	3 (10)
High	12 (15)	6 (19)
TNM stage			0.053
I + II	23 (25)	4 (10)
III + IV	68 (75)	35 (90)
BMI, kg/m2			< 0.001
≥ 22.5	60 (73)	11 (34)
< 22.5	22 (27)	21 (66)
CEA, ng/mL			0.732
≤ 5.30	56 (76)	21 (72)
> 5.30	18 (24)	8 (28)
CA19-9, U/mL			0.049
≤ 47.8	47 (58)	14 (38)
> 47.8	35 (42)	23 (62)
Maximal tumor diameter, cm			0.940
≤ 2.90	44 (50)	20 (53)
> 2.90	44 (50)	18 (47)

BMI: Body mass index; TNM: Tumor–node–metastasis; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; GPR: Gamma-glutamyl transferase–to–platelet ratio.

Table 3 Short-term clinical outcomes according to gamma-glutamyl transferase–to–platelet ratio

Patients	GPR ≤ 0.365, medium (IQR) or n (%)	GPR > 0.365, medium (IQR) or n (%)	P value
Postoperative complications			0.015
No	76 (84)	25 (64)
Yes	15 (16)	14 (36)
HOD	13 (10-17)	19 (14-23)	< 0.001

GPR: Gamma-glutamyl transferase to platelet ratio; HOD: Hospitalization days; IQR: Interquartile range.

Table 4 Univariate and multivariate Cox proportional hazard analyses of factors associated with overall survival

	Univariate test			Multivariate test
	HR	95%CI	P value	HR	95%CI	P value
Age, yr
≤ 60	1.000			1.000
> 60	1.722	1.089-2.723	0.020	1.976	1.063-3.675	0.031
Gender
Male	1.000
Female	1.033	0.834-1.278	0.769
Jaundice
No	1.000			1.000
Yes	2.378	1.423-3.977	0.001	1.064	0.462-2.450	0.883
Gallbladder stone
No	1.000
Yes	0.983	0.798-1.211	0.873
Differentiation degree of cancer cells			0.018			0.513
Low	5.583	1.870-16.666	0.002	0.860	0.089-8.327	0.897
Low-medium	3.403	1.162-9.969	0.026	0.414	0.043-4.015	0.447
Medium	3.264	1.134-9.394	0.028	0.366	0.037-3.576	0.388
Medium-high	1.980	0.630-6.226	0.243	0.549	0.057-5.277	0.604
High	2.510	0.807-7.803	0.112	0.421	0.042-4.192	0.461
BMI, kg/m2
≥ 22.5	1.000			1.000
< 22.5	3.128	1.956-5.004	< 0.001	2.776	1.394-5.529	0.004
CEA, ng/mL
≤ 5.30	1.000			1.000
> 5.30	2.485	1.478-4.178	0.001	1.477	0.800-2.726	0.212
CA19-9, U/mL
≤ 47.8	1.000			1.000
> 47.8	3.305	2.079-5.251	< 0.001	1.665	0.840-3.297	0.144
Maximal tumor diameter, cm
≤ 2.90	1.000
> 2.90		0.794-1.833	0.499
TNM stage
I + II	1.000			1.000
III + IV	6.810	2.952-15.711	< 0.001	9.093	0.998-82.830	0.050
GPR
≤ 0.365	1.000			1.000
> 0.365	2.298	1.493-3.537	< 0.001	1.974	1.008-3.867	0.047

BMI: Body mass index; TNM: Tumor–node–metastasis; CEA: Carcinoembryonic antigen; CA 19-9: Carbohydrate antigen 19-9; GPR: Gamma-glutamyl transferase–to–platelet ratio.

Table 5 Comparison of the performance and discriminative ability between different prognosis prediction models

	1-yr AUROC	3-yr AUROC	5-yr AUROC	C-index
Nomogram	0.823	0.893	0.920	0.770
TNM stage	0.649	0.748	0.778	0.631
Bai’s model1	0.766	0.857	0.848	0.773
CA19-9	0.677	0.698	0.750	0.658
MLR	0.700	0.662	0.716	0.632
NLR	0.688	0.697	0.790	0.644

¹Bai’s model: Nomogram based on jaundice, CA19-9, tumor–node–metastasis stage, and R status[34]. BMI: Body mass index; TNM: Tumor–node–metastasis; MLR: Monocyte–to–lymphocyte ratio; NLR: Neutrophil–to–lymphocyte ratio; AUROC: Area under the ROC curve; ROC: Receiver operating characteristic.