A Novel Nomogram Based on Hepatic and Coagulation Function for Evaluating Outcomes of Intrahepatic Cholangiocarcinoma After Curative Hepatectomy: A Multi-Center Study of 653 Patients.

Yunshi Cai,Hailing Liu,Bohan Zhang,Kunlin Xie,Hong Wu,Chengyou Du,Hui Li,Jiaxin Li

doi:10.3389/fonc.2021.711061

Abstract

Background and AimsHepatic and coagulation function are routine laboratory tests prior to curative hepatectomy. The prognostic value of gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR) and international normalized ratio (INR) in surgically treated patients with intrahepatic cholangiocarcinoma (ICC) remains unclear.MethodsICC patients received curative hepatectomy in two west China centers were included. Time-dependent ROC curves were conducted to compare established indexes with prognostic value for ICC. GPR-INR score was introduced and evaluated using the Time-dependent AUC curve and Kaplan-Meier survival analysis. A novel nomogram based on the GPR-INR score was proposed; Harrell’s C-index, calibration curve and decision curve analysis were used to assess this nomogram.ResultsA total of 653 patients were included. The areas under ROC curves of GPR and INR in OS and RFS were superior to other indexes. Patients with a high GPR-INR score (1,2) presented significantly decreased overall survival (OS) and recurrence-free survival (RFS); GPR-INR sore, along with several clinicopathological indexes were selected into the nomogram, the calibration curve for OS probability showed good coincidence between the nomogram and the actual surveillance. The C-index of the nomogram was 0.708 (derivation set) and 0.746 (validation set), which was more representative than the C-indexes of the GPR-INR score (0.597, 0.678). In decision curve analysis, the net benefits of the nomogram in derivation and validation set were higher than Barcelona Clinic Liver Cancer staging (BCLC) classification and American Joint Committee on Cancer (AJCC) TNM 8th staging system.ConclusionsThe proposed nomogram generated superior discriminative ability to established staging systems; it is profitable to applicate this nomogram in clinical practice.

Highlights

Liver cancer remains the second leading cause of tumor-related death in Asia, America and Africa, which leads to nearly 548,400 male deaths and 233,300 female deaths annually [1]
Patients with a high GGT to platelet ratio (GPR)-international normalized ratio (INR) score [1,2] presented significantly decreased overall survival (OS) and recurrence-free survival (RFS); GPR-INR sore, along with several clinicopathological indexes were selected into the nomogram, the calibration curve for OS probability showed good coincidence between the nomogram and the actual surveillance
The net benefits of the nomogram in derivation and validation set were higher than Barcelona Clinic Liver Cancer staging (BCLC) classification and American Joint Committee on Cancer (AJCC) TNM 8th staging system

Summary

Introduction

Liver cancer remains the second leading cause of tumor-related death in Asia, America and Africa, which leads to nearly 548,400 male deaths and 233,300 female deaths annually [1]. Intrahepatic cholangiocarcinoma (ICC) is one of the subtypes of cholangiocarcinoma which originates in the secondary bile ducts of the liver, which accounts for 10% to 30% of all primary liver malignancies, ranks only after hepatocellular carcinoma [2, 3]. ICC is associated with rapid progression, early recurrence and unsatisfying outcomes, 75% of the patients die within one year since diagnosis and the 5-year overall survival remains under 5% [4, 10]. Gemcitabine, fluoropyrimidine and Cisplatin-based systematic chemotherapy is beneficial to patients with recurrent, advanced or metastatic ICCs, but the median survival time was generally less than 12 months [7]. The prognostic value of gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR) and international normalized ratio (INR) in surgically treated patients with intrahepatic cholangiocarcinoma (ICC) remains unclear

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