JAMA Surg. 2014 May;149(5):432-8. doi: 10.1001/jamasurg.2013.5168.
Intrahepatic cholangiocarcinoma (ICC) is a primary cancer of the liver that is increasing in incidence, and the prognostic factors associated with outcome after surgery remain poorly defined.
To combine clinicopathologic variables associated with overall survival after resection of ICC into a prediction nomogram.
DESIGN, SETTING, AND PARTICIPANTS: We performed an international multicenter study of 514 patients who underwent resection for ICC at 13 major hepatobiliary centers in the United States, Europe, and Asia from May 1, 1990, through December 31, 2011. Multivariate Cox proportional hazards regression modeling with backward selection using the Akaike information criteria was used to select variables for construction of the nomogram. Discrimination and calibration were performed using Kaplan-Meier curves and calibration plots.
Surgical resection of ICC at a participating hospital.
Long-term survival, effect of potential prognostic factors, and performance of proposed nomogram.
Median patient age was 59.2 years, and 53.1% of the patients were male. Most patients (74.7%) had a solitary tumor, and median tumor size was 6.0 cm. Patients were treated with an extended hepatectomy (202 [39.3%]), a hemihepatectomy (180 [35.0%]), or a minor liver resection (<3 segments) (132 [25.7%]). Most patients underwent R0 resection (87.9%), and 35.7% of patients had N1 disease. Using the backward selection of clinically relevant variables, we found that age at diagnosis (hazard ratio [HR], 1.31; P < .001), tumor size (HR, 1.50; P < .001), multiple tumors (HR, 1.58; P < .001), cirrhosis (HR, 1.51; P = .08), lymph node metastasis (HR, 1.78; P = .01), and macrovascular invasion (HR, 2.10; P < .001) were selected as factors predictive of survival. On the basis of these factors, a nomogram was created to predict survival of ICC after resection. Discrimination using Kaplan-Meier curves, calibration curves, and bootstrap cross-validation revealed good predictive abilities (C index, 0.692).
On the basis of an Eastern and Western experience, a nomogram was developed to predict overall survival after resection for ICC. Validation revealed good discrimination and calibration, suggesting clinical utility to improve individualized predictions of survival for patients undergoing resection of ICC.
肝内胆管细胞癌（ICC）是一种原发性肝癌，其发病率正在增加，与手术后结局相关的预后因素仍未得到明确界定。
将与 ICC 切除术后总体生存相关的临床病理变量结合到一个预测列线图中。
设计、地点和参与者：我们对 1990 年 5 月 1 日至 2011 年 12 月 31 日期间在美国、欧洲和亚洲的 13 个主要肝胆中心接受 ICC 切除术的 514 例患者进行了一项国际多中心研究。使用向后选择的 Akaike 信息准则的多变量 Cox 比例风险回归模型用于选择构建列线图的变量。使用 Kaplan-Meier 曲线和校准图进行区分度和校准评估。
在参与医院进行 ICC 切除术。
长期生存、潜在预后因素的影响以及提出的列线图的性能。
中位患者年龄为 59.2 岁，53.1%的患者为男性。大多数患者（74.7%）有单个肿瘤，肿瘤大小中位数为 6.0cm。患者接受了扩大肝切除术（202 [39.3%]）、半肝切除术（180 [35.0%]）或小范围肝切除术（<3 个节段）（132 [25.7%]）。大多数患者接受了 R0 切除术（87.9%），35.7%的患者存在 N1 疾病。通过对临床相关变量的向后选择，我们发现诊断时的年龄（风险比[HR]，1.31；P<0.001）、肿瘤大小（HR，1.50；P<0.001）、多个肿瘤（HR，1.58；P<0.001）、肝硬化（HR，1.51；P=0.08）、淋巴结转移（HR，1.78；P=0.01）和大血管侵犯（HR，2.10；P<0.001）被选为与生存相关的预测因素。基于这些因素，创建了一个列线图来预测 ICC 切除术后的生存。使用 Kaplan-Meier 曲线、校准曲线和自举交叉验证进行区分度评估显示出良好的预测能力（C 指数，0.692）。
基于东西方的经验，开发了一个列线图来预测 ICC 切除术后的总体生存率。验证结果显示出良好的区分度和校准度，表明该列线图具有临床应用价值，可提高接受 ICC 切除术患者的生存个体化预测能力。
