Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Liver Int. 2010 Aug;30(7):996-1002. doi: 10.1111/j.1478-3231.2010.02203.x. Epub 2010 Feb 5.
To develop a clinical and prognostic scoring system predictive of survival after resection of intrahepatic cholangiocarcinomas (ICC).
Two hundred and one consecutive ICC patients (83 from Essen, Germany, 54 from New York, USA and 64 from Chiba, Japan). The scoring systems were developed utilizing the data set from Essen University and then applied to the data sets from Mount Sinai Medical Center and Chiba University for validation. Eighteen potential prognostic factors were evaluated. Statistical analysis included multivariable regression analyses with the Cox proportional hazard model, power analysis, internal validation with structural equation modelling bootstrapping and external validation. The prognostic scoring model was based mainly in pathological and demographical variables, whereas the clinical scoring model was based mainly in radiological and demographical variables.
Gender (P=0.0086), UICC stage (P=0.0140) and R-class (P=0.0016) were predictive of survival for the prognostic scoring model, while gender (P=0.0023), CA 19-9 levels (P=0.0153) and macrovascular invasion (P=0.0067) were predictive of survival for the clinical scoring model. Prognostic points were assigned as follows: female:male=1:2 points, UICC (I-II):UICC (III-IV)=1:2 points and R0:R1=1:2 points. Clinical points were allocated as follows: female:male=1:2 points, CA 19-9 (<100 U/ml):CA 19-9 (> or =100 U/ml)=1:2 points and no macrovascular invasion:macrovascular invasion=1:2 points. Prognostic groups with 3-4, 5 and 6 points (P=0.000001) and clinical groups with 3-4 and 5-6 points (P=0.0103) achieved statistically significant difference.
We propose a clinical and prognostic scoring system predictive of long-term survival after surgical resections for ICC.
开发一种临床和预后评分系统，以预测肝内胆管细胞癌（ICC）切除术后的生存情况。
201 例连续 ICC 患者（德国埃森 83 例，美国纽约 54 例，日本千叶 64 例）。评分系统的开发利用了埃森大学的数据集，然后应用于西奈山医学中心和千叶大学的数据集进行验证。评估了 18 个潜在的预后因素。统计分析包括多变量回归分析与 Cox 比例风险模型、功效分析、结构方程建模 bootstrap 内部验证和外部验证。预后评分模型主要基于病理和人口统计学变量，而临床评分模型主要基于影像学和人口统计学变量。
性别（P=0.0086）、UICC 分期（P=0.0140）和 R 分级（P=0.0016）是预后评分模型预测生存的因素，而性别（P=0.0023）、CA 19-9 水平（P=0.0153）和大血管侵犯（P=0.0067）是临床评分模型预测生存的因素。预后评分模型的预后评分点如下：女性：男性=1:2 分，UICC（I-II）：UICC（III-IV）=1:2 分，R0：R1=1:2 分。临床评分模型的临床评分点如下：女性：男性=1:2 分，CA 19-9（<100 U/ml）：CA 19-9（≥100 U/ml）=1:2 分，无大血管侵犯：大血管侵犯=1:2 分。预后评分 3-4 分、5 分和 6 分（P=0.000001）和临床评分 3-4 分和 5-6 分（P=0.0103）的组间差异有统计学意义。
我们提出了一种预测 ICC 手术后长期生存的临床和预后评分系统。
