Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, Fujian Province, People's Republic of China.
Department of Hepatobiliary Surgery III, Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, Shanghai, China.
BMC Cancer. 2021 Dec 5;21(1):1299. doi: 10.1186/s12885-021-09035-5.
At present, hepatectomy is still the most common and effective treatment method for intrahepatic cholangiocarcinoma (ICC) patients. However, the postoperative prognosis is poor. Therefore, the prognostic factors for these patients require further exploration. Whether microvascular invasion (MVI) plays a crucial role in the prognosis of ICC patients is still unclear. Moreover, few studies have focused on preoperative predictions of MVI in ICC patients.
Clinicopathological data of 704 ICC patients after curative resection were retrospectively collected from 13 hospitals. Independent risk factors were identified by the Cox or logistic proportional hazards model. In addition, the survival curves of the MVI-positive and MVI-negative groups before and after matching were analyzed. Subsequently, 341 patients from a single center (Eastern Hepatobiliary Hospital) in the above multicenter retrospective cohort were used to construct a nomogram prediction model. Then, the model was evaluated by the index of concordance (C-Index) and the calibration curve.
After propensity score matching (PSM), Child-Pugh grade and MVI were independent risk factors for overall survival (OS) in ICC patients after curative resection. Major hepatectomy and MVI were independent risk factors for recurrence-free survival (RFS). The survival curves of OS and RFS before and after PSM in the MVI-positive groups were significantly different compared with those in the MVI-negative groups. Multivariate logistic regression results demonstrated that age, gamma-glutamyl transpeptidase (GGT), and preoperative image tumor number were independent risk factors for the occurrence of MVI. Furthermore, the prediction model in the form of a nomogram was constructed, which showed good prediction ability for both the training (C-index = 0.7622) and validation (C-index = 0.7591) groups, and the calibration curve showed good consistency with reality.
MVI is an independent risk factor for the prognosis of ICC patients after curative resection. Age, GGT, and preoperative image tumor number were independent risk factors for the occurrence of MVI in ICC patients. The prediction model constructed further showed good predictive ability in both the training and validation groups with good consistency with reality.
目前，肝切除术仍是治疗肝内胆管细胞癌（ICC）患者的最常用和最有效的方法。然而，术后预后较差。因此，这些患者的预后因素需要进一步探讨。微血管侵犯（MVI）是否在 ICC 患者的预后中起关键作用尚不清楚。此外，很少有研究关注 ICC 患者术前对 MVI 的预测。
回顾性收集 13 家医院 704 例接受根治性切除术的 ICC 患者的临床病理资料。采用 Cox 或 logistic 比例风险模型确定独立危险因素。此外，还分析了 MVI 阳性和 MVI 阴性组患者匹配前后的生存曲线。随后，对上述多中心回顾性队列中的 341 例来自单一中心（东方肝胆外科医院）的患者进行构建列线图预测模型。然后，通过一致性指数（C-指数）和校准曲线评估模型。
经过倾向评分匹配（PSM）后，Child-Pugh 分级和 MVI 是 ICC 患者根治性切除术后总生存（OS）的独立危险因素。大肝切除术和 MVI 是无复发生存（RFS）的独立危险因素。PSM 前后 MVI 阳性组 OS 和 RFS 的生存曲线与 MVI 阴性组相比差异有统计学意义。多因素 logistic 回归结果表明，年龄、γ-谷氨酰转肽酶（GGT）和术前影像肿瘤数目是 MVI 发生的独立危险因素。此外，还构建了以列线图形式呈现的预测模型，该模型在训练组（C 指数=0.7622）和验证组（C 指数=0.7591）中均具有良好的预测能力，校准曲线显示与现实具有良好的一致性。
MVI 是 ICC 患者根治性切除术后预后的独立危险因素。年龄、GGT 和术前影像肿瘤数目是 ICC 患者 MVI 发生的独立危险因素。所构建的预测模型在训练组和验证组中均具有良好的预测能力，与现实具有良好的一致性。
