Preoperative prediction of curative surgery of perihilar cholangiocarcinoma by combination of endoscopic ultrasound and computed tomography

Abstract

Background: Perihilar cholangiocarcinomas are often considered incurable. Late diagnosis is common. Advanced disease therefore frequently causes questioning of curative surgical outcome.

Aim: This study aimed to develop a prediction model of curative surgery in patients suffering from perihilar cholangiocarcinomas based on preoperative endosonography and computer tomography.

Methods: A cohort of 81 patients (median age 67 (54-75) years, 62% male) with perihilar cholangiocarcinoma was retrospectively analyzed. Multivariate logistic regression analysis of staging variables taken from the European Staging System was performed and applied to ROC analysis.

Results: The correlation of predicted rates of eligibility for surgery with actual rates reached AUC values between 0.652 and 0.758 for endosonography and computer tomography (p < 0.05 each). Best prediction for curative surgical option was achieved by combining endosonography and computer tomography (AUC: 0.787; 95% CI 0.680-0.893, p < 0.0001). A predictive model (pSurg) was developed using multivariate analysis.

Conclusions: Our predictive web-based model pSurg with inclusion of T, N, M, B, PV, HA and V stage of the recently published European Staging System for perihilar cholangiocarcinoma results in highly significant predictability for curative surgery when combining preoperative endosonography and computer tomography, thus allowing for better patient selection in terms of possibility of curative surgery.

Keywords: CCC; cholangiocarcinoma; operability; prediction; score.

Figure 1.

Correlation of predicted (EUS) versus actual rates of eligibility for surgery in the patient cohort with Klatskin tumors (AUC:0.652; 95%CI 0.530–0.775, p = 0.022). Bold line: ROC curve. EUS: endoscopic ultrasonography.

Figure 2.

Correlation of predicted (CT) versus actual rates of eligibility for surgery in the patient cohort with Klatskin tumors (AUC:0.758; 95%CI 0.643–0.873, p < 0.0001). Bold line: ROC curve. CT: computed tomography.

Figure 3.

Correlation of predicted (EUS and CT) versus actual rates of eligibility for surgery in the patient cohort with Klatskin tumors (AUC:0.786; 95%CI 0.679–0.892, p < 0.0001). Bold line: ROC curve. CT: computed tomography; EUS: endoscopic ultrasonography.

Figure 4.

Predicted versus actual rates of curative surgery. Patients were classified into quarters according to their individual predicted probability of curative surgery (boxes represent the IQR; whiskers indicate the minimum and maximum values, but are not longer than 2 times the length of the corresponding box), which is plotted against the actual curative surgery rate for the quarters.