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Erschienen in: Journal of Gastrointestinal Surgery 3/2018

19.01.2018 | Original Article

The Limitations of Standard Clinicopathologic Features to Accurately Risk-Stratify Prognosis after Resection of Intrahepatic Cholangiocarcinoma

verfasst von: Fabio Bagante, Katiuscha Merath, Malcolm H. Squires, Matthew Weiss, Sorin Alexandrescu, Hugo P. Marques, Luca Aldrighetti, Shishir K. Maithel, Carlo Pulitano, Todd W. Bauer, Feng Shen, George A. Poultsides, Olivier Soubrane, Guillaume Martel, B. Groot Koerkamp, Alfredo Guglielmi, Endo Itaru, Timothy M. Pawlik

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 3/2018

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Abstract

Background

The ability to provide accurate prognostic data after hepatectomy for intrahepatic cholangiocarcinoma (ICC) remains poor. We sought to develop and validate a nomogram to predict survival, as well as investigate the clinical implications of underestimating patients’ risk of recurrence.

Methods

Patients undergoing curative-intent resection of ICC between 1990 and 2015 at 14 major hepatobiliary centers were included. Variables significant on multivariable analysis were used to construct a nomogram to predict disease-free survival (DFS). The nomogram assigned a score to each variable included in the model and calculated the risk of recurrence.

Results

Eight hundred ninety-seven patients are included in the analytic cohort. On multivariable Cox regression analysis, tumor size > 5 cm (HR 1.98, 95% CI 1.44–2.13; p < 0.001), multifocal ICC (HR 1.64, 95% CI 1.32–2.03; p < 0.001), lymph node metastasis (HR 1.63, 95% CI 1.25–2.11; p < 0.001), poorly differentiated tumor grade (HR 1.50, 95% CI 1.21–1.89; p < 0.001), and periductal infiltrating type (PI) morphology (HR 1.42, 95% CI 1.09–1.83; p = 0.008) were independent adverse risk factors associated with decreased DFS. The Harrell’s c-index for the nomogram was 0.633 (with n = 5000 bootstrapping resamples) and the plot comparing predicted and actuarial DFS demonstrated a good calibration of the model. A subset of patients (n = 282) had a DFS worse than predicted (ΔPredicted DFS − Actuarial DFS > 6 months). Moreover, underestimation of a recurrence risk was more common among patients with clinicopathologic features traditionally considered “favorable.”

Conclusion

A nomogram based on standard clinicopathologic characteristics was suboptimal in its ability to predict accurately risk of recurrence among patients with ICC after curative-intent liver resection. Particularly, the risk of underestimating patient risk of recurrence was highest among patients with historically favorable characteristics. Over one third of patients recurred > 6 months earlier than the DFS predicted by the nomogram.
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Metadaten
Titel
The Limitations of Standard Clinicopathologic Features to Accurately Risk-Stratify Prognosis after Resection of Intrahepatic Cholangiocarcinoma
verfasst von
Fabio Bagante
Katiuscha Merath
Malcolm H. Squires
Matthew Weiss
Sorin Alexandrescu
Hugo P. Marques
Luca Aldrighetti
Shishir K. Maithel
Carlo Pulitano
Todd W. Bauer
Feng Shen
George A. Poultsides
Olivier Soubrane
Guillaume Martel
B. Groot Koerkamp
Alfredo Guglielmi
Endo Itaru
Timothy M. Pawlik
Publikationsdatum
19.01.2018
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 3/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3682-4

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