A novel online prognostic tool to predict long‐term survival after liver resection for intrahepatic cholangiocarcinoma: The “metro‐ticket” paradigm

Abstract

Background The aim of the current study was to develop an online calculator to predict survival after liver resection for intrahepatic cholangiocarcinoma (ICC) based on the “metro‐ticket” paradigm. Methods Between 1990 and 2016, patients who underwent liver resection for ICC were identified in an international multi‐institutional database. The final multivariable model of survival was used to develop an online prognostic calculator of survival. Results Among 643 patients, actual 5‐year overall survival (OS) after resection for ICC was 42.7%. On multivariable analysis, CA19‐9 > 200 (hazard ratio (HR), 2.62; 95% CI, 2.01‐3.42), sum of the number and largest tumor size >7 (HR, 1.88; 95% CI, 1.46‐2.42), N1 disease (HR, 2.87; 95% CI, 1.98‐4.16), R1 resection (HR, 1.72; 95% CI, 1.21‐2.46), poor/undifferentiated tumor grade (HR, 1.74; 95% CI, 1.25‐2.44), major vascular invasion (HR, 1.47; 95% CI, 1.03‐2.10), and adjuvant chemotherapy (HR, 0.64; 95% CI, 0.45‐0.89) were significantly associated with survival and were included in the online calculator. The predictive accuracy of the model was good to very good as the C‐statistics to predict 5‐year OS was 0.696 in the training dataset and 0.672 with bootstrapping resamples (n = 5000) in the test dataset. Conclusion A novel, online calculator was developed to estimate the 5‐year survival probability for patients undergoing resection for ICC. This tool could help provide useful information to guide treatment decision‐making and inform conversations about prognosis.

Effect of Tumor Size on Long-Term Survival After Resection for Solitary Intrahepatic Cholangiocarcinoma

“…Our results also suggested that solitary ICC was a heterogeneous group, and larger tumor size was associated with malignant pathological factors, including worse tumor differentiation ( 20 , 22 ) and VI ( 20 , 24 ). It was believed that a larger tumor size was associated with various malignant variables ( 25 – 28 ).…”

A Novel TNM Classification for Colorectal Cancers based on the Metro-ticket Paradigm

“…Several recent studies have suggested a 'metroticket' paradigm to evaluate survival [12][13][14][15][16]. This paradigm was originally proposed by Mazzaferro et al for hepatocellular cancer (HCC) and later evolved into a novel predictive tool for HCC patients after liver transplantation [12].…”

“…Based on the concept of the metro-ticket paradigm for gastric cancer, we proposed the current nTNM classification by combining the pN and pT stages, with preserved definitions of pN and pT stages. The nTNM was defined as the distance from the origin on a Cartesian plane that incorporated two variables: the pN stage (x-axis) and pT stage (y-axis); Pythagoras theorem was then used to calculate the distance of any given point from the origin of the plane (0, 0), where [(nTNM) 2 = (pN) 2 + (pT) 2 ] (Figure 1A, 1B) [12][13][14][15][16]. The nTNM classification was similar to the AJCC classification and was divided into seven subgroups: I, IIA, IIB, IIC, IIIA, IIIB, and IIIC.…”

Italian Clinical Practice Guidelines on Cholangiocarcinoma – Part II: Treatment

“…Indeed, depending on the size and location of iCCA lesions, curative resection may require extensive resection and/or resection of the extrahepatic biliary tract, a condition that may occur in many cases. In a large surgical series, 50-70% of patients required either a hemihepatectomy or extended hepatic resection [30] . The removal of clinically suspicious nodal disease is mandatory, while the role of routine lymphadenectomy is less defined, although it is current practice in many Japanese centers [1][2][3][4] .…”