Zhao Chongyu, He Chaobin, Lu Jiawei, Huang Xin, Chen Cheng, Lin Xiaojun
Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China.
Front Oncol. 2022 Apr 8;12:832038. doi: 10.3389/fonc.2022.832038. eCollection 2022.
The post-progression survival (PPS) of recurred intrahepatic cholangiocarcinoma (iCCA) patients relates to the characteristics of tumor progression. Moreover, the prediction model of PPS in those patients has not been well established. This study aimed at developing a novel nomogram for predicting PPS in recurred iCCA patients.
Clinical characteristics were retrospectively collected in 396 patients diagnosed with iCCA from cohorts of Sun Yat-sen University Cancer Center (SYSUCC) and the First Hospital of Dalian Medical University (FHDMU). The PPS in patients with different progression patterns was investigated. The nomogram of PPS was established with the Cox regression model in the primary cohort. Then the nomogram was verified in the external validation cohort.
Liver progression was the commonest pattern (42.08%) in recurred iCCA patients, while patients with local LN progression had significantly better PPS than those with other patterns. The independent prognostic factors comprised elevated CEA levels, tumor differentiation, N stage 8th, adjuvant therapy, Local LN metastasis, Liver Metastasis only, and Multiple Metastasis. The nomogram constructed on these factors achieved satisfied C-indexes of 0.794 (95% CI 0.769-0.828) and 0.827 (0.779-0.876) for the training and validation cohorts, respectively. These values were significantly higher than those of the 8th TNM stage system (all p < 0.001). The recurred iCCA patients could be precisely classified into high- and low-risk groups according to the cutoff point of this nomogram (p < 0.01).
The investigation of progression patterns and the development of this nomogram can offer new evidence to precisely postoperative and post-progression management of iCCA patients.
复发性肝内胆管癌（iCCA）患者的进展后生存期（PPS）与肿瘤进展特征相关。此外，这些患者的PPS预测模型尚未得到很好的建立。本研究旨在开发一种用于预测复发性iCCA患者PPS的新型列线图。
回顾性收集了来自中山大学肿瘤防治中心（SYSUCC）和大连医科大学附属第一医院（FHDMU）队列中396例诊断为iCCA的患者的临床特征。研究了不同进展模式患者的PPS。在主要队列中用Cox回归模型建立PPS列线图。然后在外部验证队列中对列线图进行验证。
肝转移是复发性iCCA患者最常见的模式（42.08%），而局部淋巴结转移患者的PPS明显优于其他模式的患者。独立预后因素包括CEA水平升高、肿瘤分化、N分期8期、辅助治疗、局部淋巴结转移、仅肝转移和多发转移。基于这些因素构建的列线图在训练队列和验证队列中的C指数分别达到0.794（95%CI 0.769 - 0.828）和0.827（0.779 - 0.876）。这些值显著高于第8版TNM分期系统（所有p < 0.001）。根据该列线图的截断点，复发性iCCA患者可被精确分为高风险和低风险组（p < 0.01）。
对进展模式的研究以及该列线图的开发可为iCCA患者的精确术后和进展后管理提供新的证据。
