A Lymph Node Ratio Nomogram Based Prognostic Model for Resected Distal Cholangiocarcinoma

Abstract

Introduction: Several factors have been described as prognostic factor for resected distal cholangiocarcinoma (dCC), among which lymph node metastasis that can be presented as pN0-N1-N2 and lymph node ratio (LNR). This study aimed to evaluate the prognostic value of LNR on survival and to establish a novel prognostic nomogram to predict the cancer-specific recurrence-free survival (RFS) of dCC. Methods: Between December 2006 and September 2020, patients who underwent pancreaticoduodenectomy (PD) for dCC in 10 centers were identified. Multivariate Cox analysis was used to screen independent risk factors among several prognostic factors. A nomogram prognostic staging model was established, and precision was verified by C-index. Results: A total of 415 cases have been included. Cox regression multivariate analysis indicated the LNR15% (hazard ratio [HR] 2.442, 95% CI 1.348-4.425, p = 0.003), as an independent prognostic factor for recurrence-free survival (RFS) with perineural invasion (HR 3.100, 95% CI 1.183-8.122, p = 0.021) and the radicality of PD (HR 2.276, 95% CI 1.223-4.234, p = 0.009). The C-index of the nomogram, based on the above factors, in the validation set was 0.8. Conclusion: LNR yielded a better prognostic efficiency for RFS than the American Joint Committee on Cancer N stage. The nomogram based on LNR can provide a more accurate prognosis for patients with resected dCC.