Abstract
ObjectiveTo establish nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC).MethodsA cohort of 422 patients with HCC or ICC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent differential factors. Through combining these independent differential factors, a nomogram was established for differential diagnosis between ICC and HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The results were validated using a prospective study on 98 consecutive patients operated on from January 2019 to November 2019 at the same institution.ResultsSex (OR = 9.001, 95% CI: 3.268‐24.792, P < .001), hepatitis (OR = 0.323, 95% CI: 0.121‐0.860, P = .024), alpha‐fetoprotein (AFP) (OR = 0.997, 95% CI: 0.995‐1.000, P = .046), carbohydrate antigen 19‐9 (CA199) (OR = 1.016, 95% CI: 1.007‐1.025, P < .001), and aspartate transaminase‐to‐neutrophil ratio index (ANRI) (OR = 0.904, 95% CI: 0.843‐0.969, P = .004) were the independent differential factors for ICC. Nomogram was established with well‐fitted calibration curves through incorporating these 5 factors. Comparing model 1 including gender, hepatitis, AFP, and CA199 (C index = 0.903, 95% CI: 0.849‐0.957) and model 2 enrolling AFP and CA199 (C index = 0.850, 95% CI: 0.791‐0.908), the nomogram showed a better discrimination between ICC and HCC, with a C index of 0.920 (95% CI, 0.872‐0.968). The results were consistent in the validation cohort. DCA also confirmed the conclusion.ConclusionA nomogram was established for the differential diagnosis between ICC and HCC preoperatively, and better therapeutic choice would be made if it was applied in clinical practice.
Highlights
Primary liver cancer is the sixth most common cancer and the fourth leading cause of cancer-related mortality worldwide, which consists of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and mixed hepatocellular-cholangiocarcinoma carcinoma.[1]
We found that sex, hepatitis, AFP, carbohydrate antigen 19-9 (CA199), and aspartate transaminase-to-neutrophil ratio index (ANRI) were the independent differential factors between ICC and HCC through the multivariable logistic regression analysis
AFP, and ANRI were negatively related to ICC, while female and CA199 were positive factors in this ICC differential nomogram
Summary
Primary liver cancer is the sixth most common cancer and the fourth leading cause of cancer-related mortality worldwide, which consists of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and mixed hepatocellular-cholangiocarcinoma carcinoma.[1]. Because HCC and ICC differ in therapeutic strategies and prognosis, preoperative accurate differentiation and early diagnosis are necessary to improve the treatment outcome.[5-7]. Magnetic resonance imaging (MRI) and contrast-enhanced computerized tomography (CT) are most applied to discriminate the two subtypes, but hardly to differentiate small ICC from HCC in cirrhotic livers due to their common enhancement patterns.[9-14]. Better preoperative prediction models are needed to differentiate HCC from ICC. Inflammatory indices were used to differentiate the existence of microvascular invasion in HCC.[26]. Whether inflammatory indices could be used to distinguish HCC from ICC has never been explored.
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