Abstract
ObjectivesTo establish a nomogram based on preoperative laboratory study variables using least absolute shrinkage and selection operator (LASSO) regression for differentiating combined hepatocellular cholangiocarcinoma (cHCC) from intrahepatic cholangiocarcinoma (iCCA).MethodsWe performed a retrospective analysis of iCCA and cHCC patients who underwent liver resection. Blood signatures were established using LASSO regression, and then, the clinical risk factors based on the multivariate logistic regression and blood signatures were combined to establish a nomogram for a differential preoperative diagnosis between iCCA and cHCC. The differential accuracy ability of the nomogram was determined by Harrell’s index (C-index) and decision curve analysis, and the results were validated using a validation set. Furthermore, patients were categorized into two groups according to the optimal cut-off values of the nomogram-based scores, and their survival differences were assessed using Kaplan-Meier curves.ResultsA total of 587 patients who underwent curative liver resection for iCCA or cHCC between January 2008 and December 2017 at West China Hospital were enrolled in this study. The cHCC score was based on the personalized levels of the seven laboratory study variables. On multivariate logistic analysis, the independent factors for distinguishing cHCC were age, sex, biliary duct stones, and portal hypertension, all of which were incorporated into the nomogram combined with the cHCC-score. The nomogram had a good discriminating capability, with a C-index of 0.796 (95% CI, 0.752–0.840). The calibration plot for distinguishing cHCC from iCCA showed optimal agreement between the nomogram prediction and actual observation in the training and validation sets. The decision curves indicated significant clinical usefulness.ConclusionThe nomogram showed good accuracy for the differential diagnosis between iCCA and cHCC preoperatively, and therapeutic decisions would improve if it was applied in clinical practice.
Highlights
Intrahepatic cholangiocarcinoma is the second most common primary liver cancer after hepatocellular carcinoma [1, 2]
Our exclusion criteria for this study were as follows:(1) postoperative pathology confirmed hepatocellular carcinoma (HCC) and R1 excision or tumor margin was not specified in detail [2]; the patient had a history of other extrahepatic malignancies; and [3] poor clinical data integrity
A total of 587 patients (361 men, 226 women) who underwent curative liver resection for Intrahepatic cholangiocarcinoma (iCCA) and cHCC between January 2008 and December 2017 at West China Hospital were enrolled in this study
Summary
Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer after hepatocellular carcinoma [1, 2]. Combined hepatocellular cholangiocarcinoma (cHCC) is a rare malignant liver tumor containing components of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA) [3, 4],accounting for 0.8%–14.3% of primary liver malignancies, with incidences widely varying among studies [5,6,7]. Better preoperative noninvasive prediction models are needed to differentiate cHCC from iCCA. We established a feasible and straightforward simplified nomogram based on laboratory study variables selected by the least absolute shrinkage and selection operator (LASSO) regression analysis as well as other clinical risks obtained by multivariate logistic regression for the preoperative differential diagnosis between cHCC and iCCA. LASSO regression analysis was used to reduce high-dimensional data and choose the predictive factors in the differential diagnosis of cHCC and iCCA [16, 17]
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