# Development and External Validation of a Nomogram Predicting Early Recurrence of Gallbladder Cancer Using Preoperatively Available Prognosticators: A Korean Multicenter Retrospective Study

## TL;DR

A new online tool was developed to predict early recurrence of gallbladder cancer before surgery, using preoperative factors to help guide treatment decisions.

## Contribution

A novel nomogram was developed and externally validated for predicting early gallbladder cancer recurrence using preoperative prognosticators.

## Key findings

- The nomogram identified male sex, chronic liver disease, and elevated CEA as key predictors of early recurrence.
- The model showed strong internal validation (AUC 0.872) and moderate external validation (AUC 0.703).
- The tool can support personalized treatment decisions for high-risk gallbladder cancer patients.

## Abstract

Gallbladder cancer is a rare but aggressive disease with a high likelihood of returning after surgery. Identifying patients who are at increased risk of early recurrence can help doctors make better treatment decisions before performing invasive procedures. In this study, we analyzed data from patients who underwent surgery for gallbladder cancer and identified preoperative factors that were linked to early recurrence. Based on these findings, we developed an online calculator that estimates the individual risk of early cancer return before surgery. The tool was also tested using data from other hospitals to confirm its reliability. This approach may support doctors and patients in making more personalized treatment decisions, particularly for high-risk individuals.

Background: Gallbladder cancer (GBC) is a rare and aggressive malignancy with poor prognosis and high recurrence rates, even after curative surgical resection. Early recurrence, defined as recurrence within one year after surgery, remains a major clinical concern. This study aimed to identify preoperative prognostic factors and develop a predictive model for early recurrence and overall survival in resected GBC patients. Methods: We retrospectively analyzed data from 251 patients who underwent curative-intent resection for GBC between 2008 and 2017. Logistic regression was used to identify preoperative factors associated with early recurrence. Significant variables were used to construct a nomogram, which was externally validated using a cohort of 176 patients from three independent tertiary centers. Results: The independent predictors of early recurrence included male sex, chronic liver disease, preoperative symptoms, elevated carcinoembryonic antigen (CEA), sarcopenic obesity, clinical T3 or higher stage, and suspected metastatic lymph nodes. The nomogram demonstrated strong predictive performance with an AUC of 0.872 (95% CI: 0.817–0.927) in internal validation and 0.703 (95% CI: 0.613–0.793) in external validation. Conclusions: We developed and externally validated a novel nomogram that predicts early recurrence in GBC using only preoperative factors. This model may support individualized risk assessment and aid surgeons and patients in shared decision-making prior to high-risk surgery.