Abstract
Surgical resection is the treatment of choice for intrahepatic cholangiocarcinoma (IHCC). However, discrepancies between preoperative workup and intraoperative findings can occur, resulting in unexpected and unfavorable surgical outcomes. The aim of this study was to develop a feasible preoperative nomogram to predict futile resection of IHCC. A total of 718 patients who underwent curative-intent surgery for IHCC between January 2005 and December 2014 were included. The patients were divided into a training cohort (2005–2010, n = 377) and validation cohort (2011–2014, n = 341). The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curves. In multivariate analysis of the training cohort, tumor number, lymph node enlargement, presence of intrahepatic duct stones, and elevated neutrophil-to-lymphocyte ratio (NLR) (≥2.7) were independently correlated with the risk of futile resection. The predictive nomogram was established based on these factors. The concordance index of the nomogram for the training and the validation cohorts was 0.847 and 0.740, respectively. In this nomogram, the negative predictive value (128 points, probability of futile resection of 36%) in the validation cohort was 93.3%. In conclusion, our novel preoperatively applicable nomogram is a feasible method to predict futile resection of IHCC in curative-intent surgery.
Highlights
Intrahepatic cholangiocarcinoma (IHCC), a bile duct neoplasm located mainly in the hepatic parenchyma, is the second most common primary liver cancer after hepatocellular carcinoma[1]
Surgical resection offers the only chance of a cure in the case of IHCC
A novel preoperative nomogram to predict futile resection was developed based on a preoperative workup, and validation was performed
Summary
Intrahepatic cholangiocarcinoma (IHCC), a bile duct neoplasm located mainly in the hepatic parenchyma, is the second most common primary liver cancer after hepatocellular carcinoma[1]. Following issues were reported as the main causes of R2 resection: the unexpected presence of locally advanced tumors, multiple intrahepatic metastases in both lobes, or peritoneal seeding not clearly seen on imaging studies[5]. These can result in unnecessary surgery-related morbidity and delays in palliative treatment (e.g., chemotherapy or radiotherapy). The aim of this study was to identify preoperative predictors of futile resection at surgical exploration in patients with well-preserved liver function and potentially resectable IHCC, and to build a patient-based practical nomogram to predict futile resection using the derived variables
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