Discussion
tumor, gallbladder cancer, Tumor, malignancy, cancer
TUMOR, GALLBLADDER CANCER, RECRUITMENT, TUMOR, CANCER
In this study, we acquired GBC RNA-seq data from the GEO database and analyzed the genetic characteristics of elderly GBC patients. Our data set comprised 14 GBC patients, including four elderly and ten young patients. We performed genetic correlation analysis on age subgroups and discovered significant differences in the gene expression profiles of elderly and young GBC patients. Using WGCNA analysis, we identified a significant reduction in the expression of ND1, ND2, ND3, ND4, ND4L, CYTB, COX1, COX2, ATP6, and ATP8 genes, all of which are associated with mitochondrial respiratory enzyme functions in elderly GBC patients.Additionally, pathway enrichment analysis results suggested that elderly GBC patients experience a significant decrease in aerobic metabolic processes, leading to reduced energy metabolism. Notably, few studies have investigated the metabolic aspects of GBC, making our findings particularly noteworthy. The reduced energy metabolic process observed in elderly GBC patients may hinder antitumor immune processes and drug metabolism, exacerbating the malignancy of aged GBC. Moreover, our study revealed an upregulation in the expression of cell cycle genes in elderly GBC patients, which could further contribute to their higher malignancy.In addition, we successfully developed two nomograms to predict OS and CSS at 1-, 3-, and 5-year for elderly patients with GBC based on a large population from the SEER database. The predictive accuracy and capability of our nomograms were further verified in both the training cohort and validation cohort. Several independent prognostic predictors were identified and enrolled in our nomograms. Marital status, age, tumor grade, surgery information, T stage, N stage, and M stage were applied for OS prediction. Tumor grade, tumor size, chemotherapy, surgery information, T stage, N stage, and M stage were applied for CSS prediction.Good experience and emotional support from marriage may positively help patients to struggle with cancer. Marital status has been determined as a protective risk factor of OS for patients with GBC (The clinical treatment of GBC is a comprehensive strategy, with the chief component being surgical resection (Radiotherapy can serve as a valuable supplementary therapy for particular groups of patients, particularly those at a higher risk of recurring cancer, such as individuals who have undergone an R1 resection or those who have tested positive for lymph nodes. A study conducted previously demonstrated that the implementation of adjuvant radiotherapy resulted in an increased survival rate among patients who had been diagnosed with gallbladder cancer and were also affected by regional lymph node metastasis (Despite the robust predictive accuracy and capability of our nomograms, there were still several limitations of this present study. Above all, relevant treatment information, blood test data, and essential clinical characteristics of patients with GBC were not provided in the SEER database, such as chemotherapy regimens, radiation dose, blood routine tests, liver function, tumor markers, smoke, alcohol consumption, etc. Recruitment of these factors may help to optimize the predictive accuracy of nomograms. Second, multi-omics data are recommended to improve nomograms to emphasize precision medicine. Besides, our data are all from the U.S. population, and their applicability to populations in other countries remains to be verified, and additional multicenter prospective studies are needed to validate our findings.