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. 2022 Apr;13(2):833-846.
doi: 10.21037/jgo-21-543.

Prognostic nomogram for predicting cancer-specific survival in patients with resected hilar cholangiocarcinoma: a large cohort study

Zhimin Yu  1   2 , Qinghua Liu  1   2 , Hao Liao  1   2 , Juanyi Shi  1   2 , Zhenyu Zhou  1   2 , Yongcong Yan  1   2 , Junyao Xu  1   2 , Chuanchao He  1   2 , Kai Mao  1   2 , Jianlong Zhang  1   2 , Jie Wang  1   2 , Zhiyu Xiao  1   2
Affiliations

Prognostic nomogram for predicting cancer-specific survival in patients with resected hilar cholangiocarcinoma: a large cohort study

Zhimin Yu et al. J Gastrointest Oncol. 2022 Apr.

Abstract

Background: The aim of the study was to establish and validate a novel prognostic nomogram of cancer-specific survival (CSS) in resected hilar cholangiocarcinoma (HCCA) patients.

Methods: A training cohort of 536 patients and an internal validation cohort of 270 patients were included in this study. The demographic and clinicopathological variables were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Univariate and multivariate Cox regression analysis were performed in the training cohort, followed by the construction of nomogram for CSS. The performance of the nomogram was assessed by concordance index (C-index) and calibration plots and compared with the American Joint Committee on Cancer (AJCC) staging systems. Decision curve analysis (DCA) was applied to measure the predictive power and clinical value of the nomogram.

Results: The nomogram incorporating age, tumor size, tumor grade, lymph node ratio (LNR) and T stage parameters was with a C-index of 0.655 in the training cohort, 0.626 in the validation cohort, compared with corresponding 0.631, 0.626 for the AJCC 8th staging system. The calibration curves exhibited excellent agreement between CSS probabilities predicted by nomogram and actual observation in the training cohort and validation cohort. DCA indicated that this nomogram generated substantial clinical value.

Conclusions: The proposed nomogram provided a more accurate prognostic prediction of CSS for individual patients with resected HCCA than the AJCC 8th staging system, which might be served as an effective tool to stratify resected HCCA patients with high risk and facilitate optimizing therapeutic benefit.

Keywords: Hilar cholangiocarcinoma (HCCA); SEER; cancer-specific survival (CSS); nomogram; surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-21-543/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flowchart of the study cohort.
Figure 2
Figure 2
The cancer-specific survival of hilar cholangiocarcinoma (HCCA) patients who underwent surgery stratified by different independent prognostic factors: (A) age; (B) tumor size; (C) tumor grade; (D) lymph node ratio (LNR); (E) T stage.
Figure 3
Figure 3
Nomogram for predicting the 1-, 3- and 5-year probabilities of cancer-specific survival in resected hilar cholangiocarcinoma (HCCA) patients in the training cohort. The nomogram was constructed by age, tumor grade, tumor size, lymph node ratio (LNR) and T stage. CSS, cancer-specific survival.
Figure 4
Figure 4
Calibration curves for predicting 1-, 3- and 5-year cancer-specific survival (CSS) in patients with hilar cholangiocarcinoma (HCCA) after surgery in the training cohort (A, B and C, respectively) and in the internal validation cohort (D, E and F, respectively). The X-axis represented the nomogram-predicted probability of CSS and the Y-axis represented actual observed survival. The diagonal grey line represents an ideal evaluation where the predicted probabilities were identical to that of actual observed.
Figure 5
Figure 5
Decision curve analysis (DCA) (A and B) for the nomogram and AJCC 8th staging system and clinical impact curves (C and D) of the nomogram for cancer-specific survival (CSS) in hilar cholangiocarcinoma (HCCA) patients after surgery in the training cohort (A and C) and validation cohort (B and D). In the DCA, X-axis represented threshold probability and Y-axis represented net benefit. The horizontal black line represented the assumption that all patients survived, and the grey line represented the assumption that all patients died.
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