Development and Validation of Nomogram to Predict Very Early Recurrence of Combined Hepatocellular-Cholangiocarcinoma After Hepatic Resection: A Multi-Institutional Study

Abstract

Background and Objectives Combined hepatocellular cholangiocarcinoma (cHCC) has a high incidence of early recurrence. The objective of this study is to construct a model predicting very early recurrence (VER)(ie, recurrence within 6 months after surgery) of cHCC. Methods 131 consecutive patients from Eastern Hepatobiliary Surgery Hospital served as a development cohort to construct a nomogram predicting VER by using multivariable logistic regression analysis. The model was internally and externally validated in an validation cohort of 90 patients from Mengchao Hepatobiliary Hospital using the C concordance statistic, calibration analysis and decision curve analysis (DCA). Results The VER nomogram contains microvascular invasion(MiVI), macrovascular invasion(MaVI) and CA19-9>25mAU/mL. The model shows good discrimination with C-indexes of 0.77 (95%CI: 0.69 - 0.85 ) and 0.76 (95%CI:0.66 - 0.86) in the development cohort and validation cohort respectively. Decision curve analysis demonstrated that the model are clinically useful and the calibration of our model was favorable. Our model stratified patients into two different risk groups, which exhibited significantly different VER. Conclusions Our model demonstrated favorable performance in predicting VER in cHCC patients.