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. 2022 Apr 28;10(2):254-262.
doi: 10.14218/JCTH.2021.00099. Epub 2021 Jul 7.

A New Prognostic Model Covering All Stages of Intrahepatic Cholangiocarcinoma

Shuang-Nan Zhou  1 , Shan-Shan Lu  2   3 , Da-Wei Ju  4 , Ling-Xiang Yu  2 , Xiao-Xiao Liang  2   5 , Xiao Xiang  6 , Suthat Liangpunsakul  7   8 , Lewis R Roberts  9 , Yin-Ying Lu  2 , Ning Zhang  2
Affiliations

A New Prognostic Model Covering All Stages of Intrahepatic Cholangiocarcinoma

Shuang-Nan Zhou et al. J Clin Transl Hepatol. .

Abstract

Background and aims: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy that causes a poor survival. We aimed to identify its prognostic factors and to develop a nomogram that will predict survival of ICC patients among all stages.

Methods: A total of 442 patients with pathology-proven ICC registered at the Fifth Medical Center of PLA General Hospital between July 2007 and December 2019 were enrolled. Subjects were followed for survival status until June 30, 2020. A prognostic model visualized as a nomogram was constructed in the training cohort using multivariate cox model, and was then validated in the validation cohort.

Results: The median age was 55 years. With a median follow-up of 50.4 months, 337 patients died. The median survival was 11.6 months, with 1-, 3- and 5-year survival rates of 48.3%, 22.7% and 16.2%, respectively. Factors associated with overall survival were multiple tumors, lymph node involvement, vascular invasion, distant metastasis, decreased albumin, elevated lactate dehydrogenase (LDH), decreased iron, elevated fibrinogen, elevated CA125 and elevated CA19-9. A nomogram predicting survival of ICC patients at the time of diagnosis achieved a Harrel's c-statistic of 0.758, significantly higher than the 0.582 of the TNM stage alone. Predicted median survivals of those within the low, mid and high-risk subgroups were 35.6, 12.1 and 6.2 months, respectively.

Conclusions: A nomogram based on imaging data and serum biomarkers at diagnosis showed good ability to predict survival in patients with all stages of ICC. Further studies are needed to validate the prognostic capability of our new model.

Keywords: Intrahepatic cholangiocarcinoma; Nomogram; Prognostic model; Risk stratification.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. Nomogram for prediction of survival probability at 12, 24 and 36 months.
To use the nomogram, find the position of each parameter on the corresponding axis, draw a line to the point axis at the top for the number of points, add the total points from all of the variables, and draw a line from the total point axis to determine the OS probability at different time points at the bottom of the nomogram.
Fig. 2
Fig. 2. Calibration plot for the new nomogram associated with the prediction of 12-month survival.
Fig. 3
Fig. 3. Kaplan-Meier curves demonstrating the differences in OS among low, mid and high-risk patients stratified by the prognostic score for ICC.
See this image and copyright information in PMC

References

    1. Buettner S, van Vugt JL, IJzermans JN, Groot Koerkamp B. Intrahepatic cholangiocarcinoma: current perspectives. Onco Targets Ther. 2017;10:1131–1142. doi: 10.2147/OTT.S93629. - DOI - PMC - PubMed
    1. Florio AA, Ferlay J, Znaor A, Ruggieri D, Alvarez CS, Laversanne M, et al. Global trends in intrahepatic and extrahepatic cholangiocarcinoma incidence from 1993 to 2012. Cancer. 2020;126(11):2666–2678. doi: 10.1002/cncr.32803. - DOI - PMC - PubMed
    1. Tsilimigras DI, Sahara K, Wu L, Moris D, Bagante F, Guglielmi A, et al. Very early recurrence after liver resection for intrahepatic cholangiocarcinoma: Considering alternative treatment approaches. JAMA Surg. 2020;155(9):823–831. doi: 10.1001/jamasurg.2020.1973. - DOI - PMC - PubMed
    1. Banales JM, Cardinale V, Carpino G, Marzioni M, Andersen JB, Invernizzi P, et al. Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) Nat Rev Gastroenterol Hepatol. 2016;13(5):261–280. doi: 10.1038/nrgastro.2016.51. - DOI - PubMed
    1. Khan SA, Davidson BR, Goldin RD, Heaton N, Karani J, Pereira SP, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut. 2012;61(12):1657–1669. doi: 10.1136/gutjnl-2011-301748. - DOI - PubMed