Jeong Seogsong, Cheng Qingbao, Huang Lifeng, Wang Jian, Sha Meng, Tong Ying, Xia Lei, Han Longzhi, Xi Zhifeng, Zhang Jianjun, Kong Xiaoni, Gu Jinyang, Xia Qiang
Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Dongfang Road, NO. 1630, Shanghai, 200127, China.
Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
BMC Cancer. 2017 Jul 3;17(1):464. doi: 10.1186/s12885-017-3464-5.
Previous nomograms for intrahepatic cholangiocarcinoma (ICC) were conducted to predict overall survival, which could be influenced by various factors. Herein, we conducted our nomogram to predict recurrence of the tumor only after hepatic resection.
The nomogram was established with prognostic factors for the relapse-free survival (RFS) analyzed from our single center cohort and was evaluated by comparing with the American Joint Committee on Cancer (AJCC) staging system for the predictive accuracy.
Seropositivity of hepatitis B surface antigen (hazard ratio [HR], 0.505; 95% confidence interval [CI], 0.279 to 0.914; P = 0.024), tumor size of larger than 5 cm (HR, 1.947; 95% CI, 1.177 to 3.219; P = 0.009), Child-Pugh score of B (HR, 3.067; 95% CI, 1.293 to 7.275; P = 0.011), and lymph node metastasis (HR, 2.790; 95% CI, 1.628 to 4.781; P < 0.001) were found to be independent prognostic factors that significantly affected RFS. The calibration curve for the prediction revealed excellent agreement between estimation by our stratification system and actual RFS. The concordance C index of the nomogram (0.71; 95% CI, 0.65 to 0.77) revealed to be significantly higher than the AJCC staging system (0.66; 95% CI, 0.60 to 0.72). In the validation cohort, our risk stratification system (C-index 0.65; 95% CI, 0.59 to 0.71) also revealed more precise prediction than the AJCC staging system (C-index, 0.57; 95% CI, 0.50 to 0.64).
Our nomogram could more accurately predict recurrence of ICC after hepatic resection than the AJCC staging system.
既往用于肝内胆管癌（ICC）的列线图是用于预测总生存期的，而总生存期可能受多种因素影响。在此，我们构建列线图仅用于预测肝切除术后肿瘤的复发情况。
利用我们单中心队列中分析出的无复发生存期（RFS）的预后因素构建列线图，并通过与美国癌症联合委员会（AJCC）分期系统比较预测准确性进行评估。
乙肝表面抗原血清阳性（风险比[HR]，0.505；95%置信区间[CI]，0.279至0.914；P = 0.024）、肿瘤大小大于5 cm（HR，1.947；95% CI，1.177至3.219；P = 0.009）、Child-Pugh B级评分（HR，3.067；95% CI，1.293至7.275；P = 0.011）以及淋巴结转移（HR，2.790；95% CI，1.628至4.781；P < 0.001）被发现是显著影响RFS的独立预后因素。预测的校准曲线显示我们的分层系统估计值与实际RFS之间具有良好的一致性。列线图的一致性C指数（0.71；95% CI，0.65至0.77）显著高于AJCC分期系统（0.66；95% CI，0.60至0.72）。在验证队列中，我们的风险分层系统（C指数0.65；95% CI，0.59至0.71）也显示出比AJCC分期系统（C指数，0.57；95% CI，0.50至0.64）更精确的预测。
与AJCC分期系统相比，我们的列线图能够更准确地预测肝切除术后ICC的复发情况。
