Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
J Surg Oncol. 2019 Nov;120(6):946-955. doi: 10.1002/jso.25671. Epub 2019 Aug 13.
The objective of the current study was to characterize patients with intrahepatic cholangiocarcinoma (ICC) undergoing curative-intent surgery with discordant preoperative and postoperative prediction scores and determine factors associated with prediction discrepancy.
Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified in a multi-institutional international database. Preoperative and postoperative prognostic models were designed and discordant prognostic scores were identified. A multivariable logistic regression analysis was completed to determined factors associated with score discordance.
Among 1149 patients, those who had concordant prediction scores were older (median age, 60 vs 56), and more likely to have a smaller median tumor size (6.0 vs 7.5 cm) (all P < .05). On multivariable logistic analysis, patients with higher neutrophil-lymphocyte ratio (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19), higher CEA levels (OR, 1.25; 95% CI, 1.04-1.50), larger tumors (OR, 1.10; 95% CI, 1.04-1.15) and suspicious lymph nodes (OR, 2.05; 95% CI, 1.25-3.36) were more likely to have preoperative and postoperative score discordance. Older patients had decreased odds of having score discordance (OR, 0.98; 95% CI, 0.96-0.99). Patients with score discordance had worse overall survival compared with patients with concordant scores (median:15.9 vs 21.7 months, P < .05).
Score discordance may reflect an aggressive variant of ICC that would benefit from early integration of multidisciplinary treatment strategies.
本研究的目的是对接受根治性手术的肝内胆管细胞癌（ICC）患者进行特征分析，这些患者的术前和术后预测评分存在差异，并确定与预测差异相关的因素。
在一个多机构国际数据库中，确定了 1990 年至 2016 年间接受肝切除术治疗 ICC 的患者。设计了术前和术后预测模型，并确定了不一致的预测评分。采用多变量逻辑回归分析确定与评分差异相关的因素。
在 1149 例患者中，具有一致预测评分的患者年龄更大（中位年龄为 60 岁比 56 岁），且肿瘤中位直径更小（6.0 cm 比 7.5 cm）（均 P <.05）。多变量逻辑回归分析显示，中性粒细胞与淋巴细胞比值较高（比值比 [OR]，1.14；95%置信区间 [CI]，1.09-1.19）、CEA 水平较高（OR，1.25；95% CI，1.04-1.50）、肿瘤较大（OR，1.10；95% CI，1.04-1.15）和可疑淋巴结（OR，2.05；95% CI，1.25-3.36）的患者更有可能出现术前和术后评分不一致。年龄较大的患者发生评分不一致的可能性降低（OR，0.98；95% CI，0.96-0.99）。与评分一致的患者相比，评分不一致的患者总生存率较差（中位数：15.9 个月比 21.7 个月，P <.05）。
评分不一致可能反映 ICC 的侵袭性变异，这将受益于多学科治疗策略的早期整合。
