Gender-Specific Disparity in Prognostic Factors and Survival Prediction for Intrahepatic Cholangiocarcinoma Undergoing Resection

Abstract

Background: There is no information whether gender-associated prognostic factor disparity exists in patients with intrahepatic cholangiocarcinoma (ICC). Methods: A total of 732 ICC patients with pathological confirmation who underwent surgical resection between Nov 2011 and Apr 2015 was studied. Detection of prognostic factors was respectively performed for male and female patients using the Cox model. Gender-dependent nomograms were generated for survival prediction. Predictive performance was validated by receiver operating curves with area under curve (AUC) and calibration curves. Spearman’s rank correlation test was performed to identify gender-associated demographic and clinical factors. Results: There were 469 (64.1%) male and 263 (35.9%) female patients with ICC. Males achieved more favorable prognosis compared to females (overall survival; hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.02-1.48; P = 0.032; recurrence-free survival; HR, 1.12; 95% CI, 0.94-1.33; P = 0.197). Survival prediction was validated to be excellent for both genders (AUC, 0.71 and 0.68). Nomograms-stratified high risk showed a HR of 2.06 (P < 0.001) and 2.08 (P = 0.006) for male and female, respectively. Male showed nearest correlation with smoking, alpha fetoprotein, hepatitis B virus infection, and liver cirrhosis, whereas serum platelet count, tumor size, carbohydrate antigen (CA) 242, CA19-9, CA125, lymph node metastasis, and carcinoembryonic antigen were mostly correlated with female. Conclusions: There is a gender-associated disparity in prognostic factors for ICC after resection. Gender-dependent respective survival prediction seems to improve predictive accuracy. Large-scale prospective studies are needed to evaluate impact of gender on outcomes of other treatment modalities. Funding Statement: This work was supported by the National Natural Science Foundation of China (81772529, 81970453), the State Key Project of China (2017YFA0504503), International Science and Technology Cooperation Program of the Ministry of Science and Technology (2011DFA32980), National Key Basic Research Program of China 973 Program (2012CB526706). Declaration of Interests: The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. Ethics Approval Statement: This study was approved by the local ethics committee and informed consents were obtained from all patients.