Development and Validation of a Prognostic Model to Predict Recurrence-Free Survival After Curative Resection for Perihilar Cholangiocarcinoma: A Multicenter Study

Abstract

Background: Recurrence is the main cause of death in perihilar cholangiocarcinoma (pCCA) patients after surgery. Identifying patients with a high risk of recurrence is important for decision-making regarding neoadjuvant therapy to improve long-term outcomes.

Aim: The objective of this study was to develop and validate a prognostic model to predict recurrence-free survival (RFS) after curative resection of pCCA.

Methods: Patients following curative resection for pCCA from January 2008 to January 2016 were identified from a multicenter database. Using random assignment, 70% of patients were assigned to the training cohort, and the remaining 30% were assigned to the validation cohort. Independent predictors of RFS after curative resection for pCCA were identified and used to construct a prognostic model. The predictive performance of the model was assessed using calibration curves and the C-index.

Results: A total of 341 patients were included. The median overall survival (OS) was 22 months, and the median RFS was 14 months. Independent predictors associated with RFS included lymph node involvement, macrovascular invasion, microvascular invasion, maximum tumor size, tumor differentiation, and carbohydrate antigen 19-9. The model incorporating these factors to predict 1-year RFS demonstrated better calibration and better performance than the 8th American Joint Committee on Cancer (AJCC) staging system in both the training and validation cohorts (C-indexes: 0.723 vs. 0.641; 0.743 vs. 0.607).

Conclusions: The prognostic model could identify patients at high risk of recurrence for pCCA to inform patients and surgeons, help guide decision-making for postoperative adjuvant therapy, and improve survival.

Keywords: oncology; perihilar cholangiocarcinoma; prognostic model; recurrence; resection.

Figure 1

Prognostic model (A) and online model (B) for the prediction of 1-, 3-, and 5-year RFS for perihilar cholangiocarcinoma. CA19-9, carbohydrate antigen 19-9; ELN, total number of lymph nodes examined; RFS, recurrence-free survival.

Figure 2

Prognostic model properties. Calibration (A, C) and ROC curves (B, D) of the prognostic model for the training (A, B) and validation cohorts (C, D). AJCC, American Joint Committee on Cancer; AUC, area under curve; RFS, recurrence-free survival.

Figure 3

Prognostic model comparisons. Decision curve analysis (A, C) and ROC curves (B, D) of the prognostic model and 8th AJCC stage for the training (A, B) and validation cohorts (C, D). AJCC, American Joint Committee on Cancer; AUC, area under curve; CI, confidence interval.

Figure 4

Recurrence-free survival of all patients between the low- and high-risk groups in the training (A) and validation cohorts (B). Overall survival of all patients between the low- and high-risk groups in the training (C) and validation cohorts (D).