Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2013 Nov 1;87(3):499-504. doi: 10.1016/j.ijrobp.2013.06.2041.
To develop nomograms for predicting the overall survival (OS) and relapse-free survival (RFS) in patients with extrahepatic bile duct cancer undergoing adjuvant chemoradiation therapy after curative resection.
From January 1995 through August 2006, a total of 166 consecutive patients underwent curative resection followed by adjuvant chemoradiation therapy. Multivariate analysis using Cox proportional hazards regression was performed, and this Cox model was used as the basis for the nomograms of OS and RFS. We calculated concordance indices of the constructed nomograms and American Joint Committee on Cancer (AJCC) staging system.
The OS rate at 2 years and 5 years was 60.8% and 42.5%, respectively, and the RFS rate at 2 years and 5 years was 52.5% and 38.2%, respectively. The model containing age, sex, tumor location, histologic differentiation, perineural invasion, and lymph node involvement was selected for nomograms. The bootstrap-corrected concordance index of the nomogram for OS and RFS was 0.63 and 0.62, respectively, and that of AJCC staging for OS and RFS was 0.50 and 0.52, respectively.
We developed nomograms that predicted survival and recurrence better than AJCC staging. With caution, clinicians may use these nomograms as an adjunct to or substitute for AJCC staging for predicting an individual's prognosis and offering tailored adjuvant therapy.
建立预测接受根治性切除术后辅助放化疗的肝外胆管癌患者总生存（OS）和无复发生存（RFS）的列线图。
1995 年 1 月至 2006 年 8 月，共有 166 例连续患者接受了根治性切除术后辅助放化疗。使用 Cox 比例风险回归进行多变量分析，并将该 Cox 模型用作 OS 和 RFS 列线图的基础。我们计算了构建的列线图和美国癌症联合委员会（AJCC）分期系统的一致性指数。
2 年和 5 年的 OS 率分别为 60.8%和 42.5%，2 年和 5 年的 RFS 率分别为 52.5%和 38.2%。选择包含年龄、性别、肿瘤位置、组织学分化、神经周围侵犯和淋巴结受累的模型用于列线图。OS 和 RFS 列线图的 bootstrap 校正一致性指数分别为 0.63 和 0.62，OS 和 RFS 的 AJCC 分期分别为 0.50 和 0.52。
我们开发的列线图预测生存和复发的效果优于 AJCC 分期。谨慎地讲，临床医生可以将这些列线图作为 AJCC 分期的辅助手段或替代方法，以预测个体的预后并提供针对性的辅助治疗。
