Abstract
BackgroundPrevious nomograms for intrahepatic cholangiocarcinoma (ICC) were conducted to predict overall survival, which could be influenced by various factors. Herein, we conducted our nomogram to predict recurrence of the tumor only after hepatic resection.MethodsThe nomogram was established with prognostic factors for the relapse-free survival (RFS) analyzed from our single center cohort and was evaluated by comparing with the American Joint Committee on Cancer (AJCC) staging system for the predictive accuracy.ResultsSeropositivity of hepatitis B surface antigen (hazard ratio [HR], 0.505; 95% confidence interval [CI], 0.279 to 0.914; P = 0.024), tumor size of larger than 5 cm (HR, 1.947; 95% CI, 1.177 to 3.219; P = 0.009), Child-Pugh score of B (HR, 3.067; 95% CI, 1.293 to 7.275; P = 0.011), and lymph node metastasis (HR, 2.790; 95% CI, 1.628 to 4.781; P < 0.001) were found to be independent prognostic factors that significantly affected RFS. The calibration curve for the prediction revealed excellent agreement between estimation by our stratification system and actual RFS. The concordance C index of the nomogram (0.71; 95% CI, 0.65 to 0.77) revealed to be significantly higher than the AJCC staging system (0.66; 95% CI, 0.60 to 0.72). In the validation cohort, our risk stratification system (C-index 0.65; 95% CI, 0.59 to 0.71) also revealed more precise prediction than the AJCC staging system (C-index, 0.57; 95% CI, 0.50 to 0.64).ConclusionsOur nomogram could more accurately predict recurrence of ICC after hepatic resection than the AJCC staging system.
Highlights
Previous nomograms for intrahepatic cholangiocarcinoma (ICC) were conducted to predict overall survival, which could be influenced by various factors
Study patients From Jan 2007 to Jul 2015, a total of 106 patients with ICC who underwent hepatic resection at Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China were included according to the following criteria: (1) patients with pathological confirmation of massforming ICC from liver specimens, (2) patients with full records of clinicopathological data, (3) patients who received hepatic resection with regional lymph node dissection, and (4) patients without distant metastasis, and the included patients were enrolled in generating risk stratification system to predict recurrence of ICC, which we named “Renji nomogram”
Unlike previous nomograms that predicted overall survival outcomes, the purpose of our nomogram was to precisely stratify patients according to risk index for recurrence of ICC and exclude irrelevant factors, such as surgical complications, which would lead to unfavorable survival outcomes [6, 14]
Summary
Previous nomograms for intrahepatic cholangiocarcinoma (ICC) were conducted to predict overall survival, which could be influenced by various factors. Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer accounting for 15 to 20% of all primary liver malignancies [1]. It is a relatively rare disease with dismal prognosis due to frequent recurrence after surgical operation, lymph node metastasis, and rapid progression of the tumor, and 5-year mortality of patients who received surgical treatments remains higher than 50% [2]. Several evaluation procedures for resection range in cirrhotic patients have already been developed and proved to be effective
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