Performance of prognostic scores and staging systems in predicting long‐term survival outcomes after surgery for intrahepatic cholangiocarcinoma

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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.

Section: Discussionmentioning

confidence: 99%

“…Long‐term outcomes following surgical resection vary and depend on a wide variety of factors. In turn, several prognostic schemes have been proposed to help both physicians and patients define the relative benefit of surgical resection, as well as estimate life expectancy following surgery …”

Section: Introductionmentioning

confidence: 99%

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

Sahara

Tsilimigras

Mehta

et al. 2019

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Section: Introductionmentioning

confidence: 99%

“…To date, there are only a few prognostic tools available for patients with ICC . In addition, most of these tools rely on factors known only after surgery as only a few models have utilized preoperative factors to stratify the long‐term prognosis . Most commonly, tumor‐associated factors such as tumor number, size, major vascular invasion as well as serum biomarkers, such as the carcinoembryonic antigen (CEA) and the cancer antigen (CA) 19‐9 have been correlated with clinical outcomes .…”

Section: Introductionmentioning

confidence: 99%

Prognostic utility of albumin‐bilirubin grade for short‐ and long‐term outcomes following hepatic resection for intrahepatic cholangiocarcinoma: A multi‐institutional analysis of 706 patients

Tsilimigras

Hyer

Moris

et al. 2019

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Background The objective of the current study was to define the impact of albumin‐bilirubin (ALBI) grade on short‐ as well as long‐term outcomes among patients with intrahepatic cholangiocarcinoma (ICC). Methods Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified using an international multi‐institutional database. Clinicopathologic factors including ALBI score were assessed using bivariate and multivariable analyses, as well as standard survival analyses. Results Among 706 patients, 453 (64.2%) patients had ALBI grade 1, 231 (32.7%) ALBI grade 2, and 22 (3.1%) had ALBI grade 3. After adjusting for all competing factors, patients with ALBI grade 2/3 had higher odds of a prolonged length‐of‐stay (>10 days, odds ratio [OR] = 2.37, 95% confidence interval [CI]:1.47‐3.80), perioperative transfusion (OR = 2.15, 95% CI:1.45‐3.18) and 90‐day mortality (OR = 2.50, 95% CI:1.16‐5.38). Median and 5‐year overall survival (OS) for the entire cohort was 41.5 months (IQR:15.7‐107.8) and 39.8%, respectively. Of note, median OS incrementally worsened with increased ALBI grade: grade 1, 49.6 months (IQR:18.3‐NR) vs grade 2, 29.6 months (IQR:12.6‐98.4) vs grade 3, 16.9 months (IQR:6.5‐32.4; P < 0.001). On multivariable analysis, higher ALBI grade remained associated with higher hazards of death (grade 2/3: hazard ratio = 1.36, 95% CI:1.04‐1.78). Conclusion The ALBI score was associated with both short‐ and long‐term outcomes following resection for ICC and could prove a useful surrogate marker to identify patients at risk for adverse outcomes.

“…The TNM staging classification is based on factors obtained postoperatively on the pathologic assessment of the tumor specimen. While several groups have proposed preoperative staging/scoring systems, preoperative scores usually underestimate or overestimate prognosis compared with the final pathologic assessment of tumors . In turn, this may be problematic during preoperative counseling of patients about the relative long‐term benefits associated with surgery and, thus, may lead to decisional regret among patients …”

Section: Introductionmentioning

confidence: 99%

Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective

Moro

Paredes

Farooq

et al. 2019

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Background The objective of the current study was to characterize patients with intrahepatic cholangiocarcinoma (ICC) undergoing curative‐intent surgery with discordant preoperative and postoperative prediction scores and determine factors associated with prediction discrepancy. Methods Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified in a multi‐institutional international database. Preoperative and postoperative prognostic models were designed and discordant prognostic scores were identified. A multivariable logistic regression analysis was completed to determined factors associated with score discordance. Results Among 1149 patients, those who had concordant prediction scores were older (median age, 60 vs 56), and more likely to have a smaller median tumor size (6.0 vs 7.5 cm) (all P < .05). On multivariable logistic analysis, patients with higher neutrophil‐lymphocyte ratio (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09‐1.19), higher CEA levels (OR, 1.25; 95% CI, 1.04‐1.50), larger tumors (OR, 1.10; 95% CI, 1.04‐1.15) and suspicious lymph nodes (OR, 2.05; 95% CI, 1.25‐3.36) were more likely to have preoperative and postoperative score discordance. Older patients had decreased odds of having score discordance (OR, 0.98; 95% CI, 0.96‐0.99). Patients with score discordance had worse overall survival compared with patients with concordant scores (median:15.9 vs 21.7 months, P < .05). Conclusion Score discordance may reflect an aggressive variant of ICC that would benefit from early integration of multidisciplinary treatment strategies.