Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, P.R. China.
J Clin Oncol. 2013 Mar 20;31(9):1188-95. doi: 10.1200/JCO.2012.41.5984. Epub 2013 Jan 28.
This study aimed to establish an effective prognostic nomogram for intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy.
The nomogram was based on a retrospectively study on 367 patients who underwent partial hepatectomy for ICC at the Eastern Hepatobiliary Surgery Hospital from 2002 to 2007. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve and compared with five currently used staging systems on ICC. The results were validated using bootstrap resampling and a prospective study on 82 patients operated on from 2007 to 2008 at the same institution.
On multivariate analysis of the primary cohort, independent factors for survival were serum carcinoembryonic antigen, CA 19-9, tumor diameter and number, vascular invasion, lymph node metastasis, direct invasion, and local extrahepatic metastasis, which were all selected into the nomogram. The calibration curve for probability of survival showed good agreement between prediction by nomogram and actual observation. The C-index of the nomogram for predicting survival was 0.74 (95% CI, 0.71 to 0.77), which was statistically higher than the C-index values of the following systems: American Joint Committee on Cancer (AJCC) seventh edition (0.65), AJCC sixth edition (0.65), Nathan (0.64), Liver Cancer Study Group of Japan (0.64), and Okabayashi (0.67; P < .001 for all). It was also higher (0.74) in predicting survival for the mass-forming type of ICC (P < .001). In the validation cohort, the nomogram discrimination was superior to the five other staging systems (C-index: 0.75 v 0.60 to 0.63; P < .001 for all).
The proposed nomogram resulted in more-accurate prognostic prediction for patients with ICC after partial hepatectomy.
本研究旨在为接受肝部分切除术的肝内胆管细胞癌（ICC）患者建立一种有效的预后列线图。
该列线图基于 2002 年至 2007 年在东方肝胆外科医院接受肝部分切除术治疗 ICC 的 367 例患者的回顾性研究。通过一致性指数（C 指数）和校准曲线来确定列线图的预测准确性和判别能力，并与目前用于 ICC 的五种分期系统进行比较。通过 bootstrap 重采样和对同一机构 2007 年至 2008 年接受手术的 82 例患者的前瞻性研究对结果进行验证。
在原发性队列的多变量分析中，独立的生存因素为血清癌胚抗原、CA 19-9、肿瘤直径和数量、血管侵犯、淋巴结转移、直接侵犯和局部肝外转移，这些因素均被纳入列线图。生存概率的校准曲线显示，列线图预测与实际观察之间具有良好的一致性。预测生存的列线图的 C 指数为 0.74（95%CI，0.71 至 0.77），统计学上高于以下系统的 C 指数值：美国癌症联合委员会（AJCC）第七版（0.65）、AJCC 第六版（0.65）、Nathan（0.64）、日本肝癌研究组（0.64）和 Okabayashi（0.67；所有 P 值均<.001）。在预测肿块形成型 ICC 的生存方面，它也更高（0.74；P<.001）。在验证队列中，该列线图的判别能力优于其他五种分期系统（C 指数：0.75 比 0.60 至 0.63；所有 P 值均<.001）。
提出的列线图可更准确地预测接受肝部分切除术的 ICC 患者的预后。
