Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, PR China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, PR China.
Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, PR China.
Eur J Surg Oncol. 2021 Mar;47(3 Pt B):603-612. doi: 10.1016/j.ejso.2020.09.002. Epub 2020 Sep 6.
Intrahepatic Cholangiocarcinoma (ICC) is the second most common primary liver cancer with dismal survival rates. This study aimed to explore the prognostic value of sarcopenia combine with hepatolithiasis in surgically treated ICC patients and develop a prognostic nomogram to help make clinical decisions.
A prospective cohort study was conducted including patients who underwent hepatectomy for ICC between August 2012 and October 2019. The association between the sarcopenia combined with hepatolithiasis and survival, including overall survival (OS) and recurrence-free survival (RFS) was investigated using the Kaplan-Meier (K-M) method. Univariable and multivariable Cox regression analysis was performed to determine the independent prognostic factors and a nomogram establishment was undertaken based on the multivariable analysis.
A total of 121 ICC patients were included in the study. K-M analysis revealed that ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS than those without sarcopenias and/or hepatolithiasis (p < 0.01). Multivariable analysis showed that age, serum CEA, hepatolithiasis, sarcopenia and diabetes were independent prognostic factors for OS(p < 0.05). Finally, a nomogram with good performance in survival prediction was established (C-index was 0.721; the area under the curve of OS was 0.837). The stratified analysis based on the nomogram disclosed that the median OS was 11.9 months in high-risk patients and 51.2 months in low-risk patients (p < 0.001).
ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS. The nomogram we developed is a practical tool that can provide a more individualized risk assessment for surgically treated ICC patients.
肝内胆管癌（ICC）是第二常见的原发性肝癌，其生存率极差。本研究旨在探讨肝内胆管癌患者中肌少症合并肝胆管结石的预后价值，并建立一个预后列线图来帮助临床决策。
进行了一项前瞻性队列研究，纳入 2012 年 8 月至 2019 年 10 月期间接受肝切除术治疗 ICC 的患者。采用 Kaplan-Meier（K-M）法研究肌少症合并肝胆管结石与生存（包括总生存（OS）和无复发生存（RFS）的关系。采用单变量和多变量 Cox 回归分析确定独立的预后因素，并基于多变量分析建立列线图。
共纳入 121 例 ICC 患者。K-M 分析表明，合并肌少症和肝胆管结石的 ICC 患者的 OS 和 RFS 较无肌少症和/或肝胆管结石的患者更差（p<0.01）。多变量分析显示，年龄、血清 CEA、肝胆管结石、肌少症和糖尿病是 OS 的独立预后因素（p<0.05）。最后，建立了一个具有良好生存预测性能的列线图（C 指数为 0.721；OS 曲线下面积为 0.837）。基于该列线图的分层分析显示，高危患者的中位 OS 为 11.9 个月，低危患者的中位 OS 为 51.2 个月（p<0.001）。
合并肌少症和肝胆管结石的 ICC 患者的 OS 和 RFS 更差。我们开发的列线图是一种实用的工具，可以为接受手术治疗的 ICC 患者提供更个体化的风险评估。
