Abstract
BackgroundAt present, hepatectomy is still the most common and effective treatment method for intrahepatic cholangiocarcinoma (ICC) patients. However, the postoperative prognosis is poor. Therefore, the prognostic factors for these patients require further exploration. Whether microvascular invasion (MVI) plays a crucial role in the prognosis of ICC patients is still unclear. Moreover, few studies have focused on preoperative predictions of MVI in ICC patients.MethodsClinicopathological data of 704 ICC patients after curative resection were retrospectively collected from 13 hospitals. Independent risk factors were identified by the Cox or logistic proportional hazards model. In addition, the survival curves of the MVI-positive and MVI-negative groups before and after matching were analyzed. Subsequently, 341 patients from a single center (Eastern Hepatobiliary Hospital) in the above multicenter retrospective cohort were used to construct a nomogram prediction model. Then, the model was evaluated by the index of concordance (C-Index) and the calibration curve.ResultsAfter propensity score matching (PSM), Child-Pugh grade and MVI were independent risk factors for overall survival (OS) in ICC patients after curative resection. Major hepatectomy and MVI were independent risk factors for recurrence-free survival (RFS). The survival curves of OS and RFS before and after PSM in the MVI-positive groups were significantly different compared with those in the MVI-negative groups. Multivariate logistic regression results demonstrated that age, gamma-glutamyl transpeptidase (GGT), and preoperative image tumor number were independent risk factors for the occurrence of MVI. Furthermore, the prediction model in the form of a nomogram was constructed, which showed good prediction ability for both the training (C-index = 0.7622) and validation (C-index = 0.7591) groups, and the calibration curve showed good consistency with reality.ConclusionMVI is an independent risk factor for the prognosis of ICC patients after curative resection. Age, GGT, and preoperative image tumor number were independent risk factors for the occurrence of MVI in ICC patients. The prediction model constructed further showed good predictive ability in both the training and validation groups with good consistency with reality.
Highlights
According to the different anatomical positions, cholangiocarcinoma can be divided into distal cholangiocarcinoma, hilar cholangiocarcinoma, and intrahepatic cholangiocarcinoma (ICC), which originate from secondary and above bile duct branches [1]
Patients were enrolled in this research if they met the following inclusion criteria: (1) ICC was confirmed by postoperative pathology; (2) curative resection (R0 resection) was performed; (3) no history of preoperative antitumor therapy; and (4) no history of distant metastasis or large vascular invasion by preoperative evaluation
Baseline characteristics A total of 765 ICC patients who underwent curative hepatectomy and met the inclusion criteria were initially taken into consideration
Summary
According to the different anatomical positions, cholangiocarcinoma can be divided into distal cholangiocarcinoma, hilar cholangiocarcinoma, and intrahepatic cholangiocarcinoma (ICC), which originate from secondary and above bile duct branches [1]. ICC is a malignant tumor derived from intrahepatic bile duct epithelium cells, and its incidence has gradually increased in recent years, and it accounts for approximately 5–20% of primary liver cancer [1, 2]. Hepatectomy remains the most common and effective treatment for ICC at present [4]. The prognosis after hepatectomy is unsatisfactory, and the 5-years survival rate is reported to be approximately 20–40%. Hepatectomy is still the most common and effective treatment method for intrahepatic cholangiocarcinoma (ICC) patients. Whether microvascular invasion (MVI) plays a crucial role in the prognosis of ICC patients is still unclear. Few studies have focused on preoperative predictions of MVI in ICC patients
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