Quality and performance of validated prognostic models for survival after resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis

Abstract

Background: The objective of this systematic review was to evaluate the performance of prognostic survival models for intrahepatic cholangiocarcinoma (iCCA) when validated in an external dataset. Furthermore, it sought to identify common prognostic factors across models, and assess methodological quality of the studies in which the models were developed. Methods: The PRISMA guidelines were followed. External validation studies of prognostic models for patients with iCCA were searched in 5 databases. Model performance was assessed by discrimination and calibration. Results: Thirteen external validation studies were identified, validating 18 different prognostic models. The Wang model was the sole model with good performance (C-index above 0.70) for overall survival. This model incorporated tumor size and number, lymph node metastasis, direct invasion into surrounding tissue, vascular invasion, Carbohydrate antigen (CA) 19-9, and carcinoembryonic antigen (CEA). Methodological quality was poor in 11/12 statistical models. The Wang model had the highest score with 13 out of 17 points. Conclusion: The Wang model for prognosis after resection of iCCA has good quality and good performance at external validation, while most prognostic models for iCCA have been developed with poor methodological quality and show poor performance at external validation.

Incidence Trend and Competing Risk Analysis of Patients With Intrahepatic Cholangiocarcinoma: A Population-Based Study

“…The AJCC staging manual is the most widely used tool for predicting the prognosis of ICCA patients ( 19 , 20 ), but some studies have proposed that the performance of the latest edition is unsatisfactory ( 41 ). In this study, we developed a novel nomogram to predict the OS of patients with ICCA, and this nomogram integrates predictors including age, gender, grade, tumor size, AJCC-T, AJCC-M, regional LN surgery and treatment.…”

Editorial for “Multiparametric MRI‐Based Radiomic Signature for Preoperative Evaluation of Overall Survival in Intrahepatic Cholangiocarcinoma After Partial Hepatectomy”

“…Currently, the most widely used staging system for patients with iCCA is the tumor–node–metastasis (TNM) staging from the American Joint Committee on Cancer, which incorporates pathological data such as tumor size, number of tumor, vascular invasion, visceral peritoneal perforation, invasion of extrahepatic structures, lymph node metastasis, and distant metastasis 3 . Along with TNM staging, numerous staging systems have been proposed, the majority of which are based on pathological data and have insufficient discriminatory performance for overall survival 4 . As these pathology‐based staging systems cannot be evaluated prior to surgery, they cannot be used to guide preoperative clinical decision‐making.…”

“…Lymph node metastasis has been recognized as a significant prognostic factor, and most pathology‐based staging systems incorporate nodal status. Therefore, lymph node dissection is recommended for all patients undergoing hepatic resection for proper prognostication 2–4 . However, due to the unclear survival benefit and concerns regarding surgical complications, approximately 50% patients with iCCA undergoing hepatic resection do not undergo lymph node dissection, and pathological nodal status is not available in such patients 5 .…”

“…3 Along with TNM staging, numerous staging systems have been proposed, the majority of which are based on pathological data and have insufficient discriminatory performance for overall survival. 4 As these pathology-based staging systems cannot be evaluated prior to surgery, they cannot be used to guide preoperative clinical decision-making. Another problem of the pathology-based staging systems is the evaluation of the pathological nodal status of iCCA.…”

“…Therefore, lymph node dissection is recommended for all patients undergoing hepatic resection for proper prognostication. [2][3][4] However, due to the unclear survival benefit and concerns regarding surgical complications, approximately 50% patients with iCCA undergoing hepatic resection do not undergo lymph node dissection, and pathological nodal status is not available in such patients. 5 Pathological staging systems can only be applied in some patients with iCCA treated with hepatic resection.…”