Abstract
BackgroundCombined hepatocellular carcinoma and cholangiocarcinoma (CHC) is an uncommon subtype of primary liver cancer. Because of limited epidemiological data, prognostic risk factors and therapeutic strategies for patients with CHC tend to be individualized. This study aimed to identify independent prognostic factors and develop a nomogram-based model for predicting the overall survival (OS) of patients with CHC.MethodsWe recruited eligible individuals from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 and randomly divided them into the training or verification cohort. Univariate and multivariate analyses were performed to identify independent variables associated with OS. Based on multivariate analysis, the nomogram was established, and its prediction performance was evaluated using the consistency index (C-index) and calibration curve.ResultsIn total, 271 patients with CHC were included in our study. The median OS was 14 months, and the 1-, 3-, and 5-year OS rates were 52.3%, 27.1%, and 23.3%, respectively. In the training cohort, multivariate analysis showed that the pathological grade (hazard ratio [HR], 1.26; 95% confidence interval [CI]: 0.96–1.66), TNM stage (HR, 1.21; 95% CI: 1.02 - 1.44), and surgery (HR, 0.26; 95% CI: 0.17 - 0.40) were independent indicators of OS. The nomogram-based model related C-indexes were 0.76 (95% CI: 0.72 - 0.81) and 0.72 (95% CI: 0.66 - 0.79) in the training and validation cohorts, respectively. The calibration of the nomogram showed good consistency of 1-, 3-, and 5-year OS rates between the actual observed survival and predicted survival in both cohorts. The TNM stage (HR, 1.23; 95% CI: 1.01 - 1.49), and M stage (HR, 1.87; 95% CI: 1.14 3.05) were risk factors in the surgical treatment group. Surgical resection and liver transplantation could significantly prolong the survival, with no statistical difference observed.ConclusionsThe pathological grade, TNM stage, and surgery were independent prognostic factors for patients with CHC. We developed a nomogram model, in the form of a static nomogram or an online calculator, for predicting the OS of patients with CHC, with a good predictive performance.
Highlights
Combined hepatocellular carcinoma and cholangiocarcinoma (CHC) is a rare tumor subtype, it accounts for only 0.4%– 14.2% of primary liver malignancies, and it has characteristics of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) [1,2,3]
CHC has an extremely poor prognosis, and its prognosis has not improved in recent years
Our study demonstrated that pathological grade, TNM stage, and surgery type were independent prognostic factors for patients with CHC
Summary
Combined hepatocellular carcinoma and cholangiocarcinoma (CHC) is a rare tumor subtype, it accounts for only 0.4%– 14.2% of primary liver malignancies, and it has characteristics of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) [1,2,3]. Despite progress in treatment strategies, CHC is still considered an aggressive liver cancer with a poor prognosis and negligible improvement in recent years [15, 16]. Complete LR is considered to be the first-line treatment strategy for resectable CHC; the median overall survival (OS) of patients with CHC who have undergone surgery was only approximately 25–35.4 months [12, 13, 17,18,19]. This study aimed to identify independent prognostic factors and develop a nomogram-based model for predicting the overall survival (OS) of patients with CHC
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