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Comparative Study
. 2016 Oct;20(10):1716-24.
doi: 10.1007/s11605-016-3203-2. Epub 2016 Jul 13.

A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

Stefan Buettner  1   2 , Jeroen L A van Vugt  2 , Faiz Gani  1 , Bas Groot Koerkamp  2 , Georgios Antonios Margonis  1 , Cecilia G Ethun  3 , George Poultsides  4 , Thuy Tran  4 , Kamran Idrees  5 , Chelsea A Isom  5 , Ryan C Fields  6 , Bradley Krasnick  6 , Sharon M Weber  7 , Ahmed Salem  7 , Robert C G Martin  8 , Charles Scoggins  8 , Perry Shen  9 , Harveshp D Mogal  9 , Carl Schmidt  10 , Eliza Beal  10 , Ioannis Hatzaras  11 , Rivfka Shenoy  11 , Shishir K Maithel  3 , Alfredo Guglielmi  12 , Jan N M IJzermans  2 , Timothy M Pawlik  13
Affiliations
Comparative Study

A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

Stefan Buettner et al. J Gastrointest Surg. 2016 Oct.

Abstract

Introduction: Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC.

Methods: Four hundred seven patients who underwent surgery for PHC between 1988 and 2014 were identified using an international, multi-center database. Standard clinicopathologic and outcome data were collected. The predictive power of the AJCC staging system and nomogram were assessed.

Results: Median survival was 24.4 months; 3- and 5-year survival was 37.2 and 20.8 %, respectively. The AJCC 7th edition staging system (C-index 0.570) and the recently proposed PHC nomogram (C-index 0.587) both performed poorly. A revised nomogram based on age, lymphovascular invasion, perineural invasion, and lymph node metastases performed better (C-index 0.682). The calibration plot of the revised PHC nomogram demonstrated good calibration.

Conclusion: The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.

Keywords: Nomogram, perihilar cholangiocarcinoma; Risk factors, prognostic tools; Survival.

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Figures

Fig. 1
Fig. 1
Nomogram to calculate the 3- and 5-year survival of patients undergoing resection for perhilar cholangiocarcinoma
Fig. 2
Fig. 2
5-year postoperative mortality stratified by tertiles predicted by our proposed nomogram
Fig. 3
Fig. 3
3- and 5-year mortality after curative resection for perihilar cholangiocarcinoma stratified by quartiles of a AJCC stage, b MSKCC nomogram, and c our proposed nomogram
Fig. 4
Fig. 4
Calibration plot for the calculated nomogram
See this image and copyright information in PMC

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