Risk stratification system to predict recurrence of intrahepatic cholangiocarcinoma after hepatic resection

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.

Latent Risk Intrahepatic Cholangiocarcinoma Susceptible to Adjuvant Treatment After Resection: A Clinical Deep Learning Approach

“…Owing to the exponential increase in the number of ICC studies, prognosis of the disease is witnessing development (15). Various prognosis-predictive systems with biological, pathological, demographic, clinical, and imaging characteristics have been developed (16,17). However, such systems could not be implemented widely due to their inaccuracy and discriminations against them.…”

A Novel Prognostic Nomogram for Patients With Recurrence of Intrahepatic Cholangiocarcinoma After Initial Surgery

“…The long-term outcome of patients after curative resection with ICC remains dismal due to a high incidence of recurrence (12). Thus, research that sheds light on the prognostic factors of postrecurrence survival of ICC patients desperately needs (25,26). However, previous studies for ICC had focused almost exclusively on variables limited to characteristics of the primary tumor, and neglected the fact that the PRS of ICC patients were greatly impacted by features of recurrence and treatment modalities (9,10,16).…”

Survival of Patients with Cholangiocarcinoma Receiving Surgical Treatment in an O. viverrini Endemic Area in Thailand: A Retrospective Cohort Study

“…According to previous studies, CCA cure is rare, with a 5-year survival ranging from 5% in intrahepatic CCA(iCCA) to 17% in extrahepatic CCA (Squadroni et al, 2017). Factors associated with survival rate of CCA after surgery include tumor size, number of tumors, lymph node metastasis, perineural invasion (PNI), lympho-vascular invasion (LVI) and marginal status (Yamamoto and Ariizumi, 2011;Song et al, 2013;Hartog et al, 2016;Bagante et al, 2017;Jeong et al, 2017;Squadroni et al, 2017;Wellner et al, 2017). However, most of these studies were done in developed countries where the natural history of CCA and its treatment may differ from those in developing countries where there are other causative factors, such as infection with the liver fluke, Opisthorchis viverrini.…”