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. 2019 Jul 24:11:6907-6929.
doi: 10.2147/CMAR.S212149. eCollection 2019.

Nomograms for predicting overall survival and cancer-specific survival in patients with surgically resected intrahepatic cholangiocarcinoma

Kexin Ma #  1 , Bing Dong #  1 , Liming Wang  1 , Chongyu Zhao  1 , Zhaoyu Fu  1 , Chi Che  1 , Wuguang Liu  1 , Zexuan Yang  1 , Rui Liang  1
Affiliations

Nomograms for predicting overall survival and cancer-specific survival in patients with surgically resected intrahepatic cholangiocarcinoma

Kexin Ma et al. Cancer Manag Res. .

Abstract

Purpose: To develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in patients with surgically resected intrahepatic cholangiocarcinoma (ICC).

Patients and methods: The nomograms were developed using a development cohort of 947 ICC patients after surgery selected from Surveillance, Epidemiology, and End Results database, and externally validated using a training cohort of 159 patients admitted at our institution. Nomograms for OS and CSS were established based on the independent prognostic factors identified by COX regression models and Fine and Grey's models, respectively. The performance of the nomograms was validated internally and externally by using the concordance index (c-index), and calibration plot, and compared with that of AJCC 8th edition TNM staging system by using c-index and decision curve analysis.

Results: Age, T stage, M stage, lymph node ratio (LNR) level and tumor grade were independent prognostic predictors for OS in ICC patients, while T stage, M stage, LNR level and tumor grade were independent prognostic predictors for CSS. Nomogram predicting OS was with a c-index of 0.751 on internal validation and 0.725 up to external validation, while nomogram for CSS was with a c-index of 0.736 on internal validation and 0.718 up to external validation. Calibration plots exhibited that the nomograms-predicted and actual OS/CSS probabilities were fitted well on both internal and external validation. Additionally, the nomograms exhibited superiority over AJCC 8th edition TNM staging system with higher c-indices and net benefit gains, in predicting OS and CSS in ICC patients after surgery.

Conclusion: The constructed nomograms could predict OS and CSS with good performance, which could be served as an effective tool for prognostic evaluation and individual treatment strategies optimization in ICC patients after surgery in clinical practice.

Keywords: cancer-specific survival; intrahepatic cholangiocarcinoma; nomogram; overall survival.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The flowchart of the study cohort.
Figure 2
Figure 2
Nomograms predicting 1-, 3- and 5-year OS (A) and CSS (B) in patients with ICC after surgery. Each subtype within these variables was assigned a score on the point scale. By summing up the total score and locating it on the total point scale, we could draw a vertical line down to get the nomogram-predicted probability at each time point. Abbreviations: CSS, cancer-specific survival; ICC, intrahepatic cholangiocarcinoma; LNR, lymph node ratio; OS, overall survival.
Figure 3
Figure 3
Calibration curves of the nomogram predicting OS in the development cohort: (A) 1-year OS; (B) 3-year OS; (C) 5-year OS. OS: overall survival.
Figure 4
Figure 4
Calibration curves of the nomogram predicting OS in the training cohort: (A) 1-year OS; (B) 3-year OS; (C) 5-year OS. Abbreviation: OS, overall survival.
Figure 5
Figure 5
Calibration curves of the nomogram predicting CSS in the development cohort: (A) 1-year CSS; (B) 3-year CSS; (C) 5-year CSS. Abbreviation: CSS, cancer-specific survival.
Figure 6
Figure 6
Calibration curves of the nomogram predicting CSS in the training cohort: (A) 1-year CSS; (B) 3-year CSS; (C) 5-year CSS. Abbreviation: CSS, cancer-specific survival.
Figure 7
Figure 7
Decision curve analysis of nomograms and AJCC 8th edition staging system for predicting (A) 1-year OS; (B) 3-year OS; (C) 5-year OS. The grey line indicates the assumption that all patients die. The black line indicates that the assumption that all patients survive. Abbreviation: OS, overall survival.
Figure 8
Figure 8
Decision curve analysis of nomograms and AJCC 8th edition staging system for predicting (A) 1-year CSS; (B) 3-year CSS; (C) 5-year CSS. The grey line indicates the assumption that all patients die. The black line indicates that the assumption that all patients survive. Abbreviation: CSS: cancer-specific survival.
See this image and copyright information in PMC

References

    1. Liver Cancer Study Group of J. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg. 1990;211(3):277–287. - PMC - PubMed
    1. Pawlik TM. Biliary tract and primary liver tumors. Surg Oncol Clin N Am. 2014;23(2):xv–xvi. doi:10.1016/j.soc.2013.11.005 - DOI - PubMed
    1. Malhi H, Gores GJ. Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol. 2006;45(6):856–867. doi:10.1016/j.jhep.2006.09.001 - DOI - PMC - PubMed
    1. Welzel TM, McGlynn KA, Hsing AW, O’Brien TR, Pfeiffer RM. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J Natl Cancer Inst. 2006;98(12):873–875. doi:10.1093/jnci/djj234 - DOI - PubMed
    1. Endo I, Gonen M, Yopp AC, et al. Intrahepatic cholangiocarcinoma: rising frequency, improved survival, and determinants of outcome after resection. Ann Surg. 2008;248(1):84–96. doi:10.1097/SLA.0b013e318176c4d3 - DOI - PubMed