Department of Clinical Laboratory, The Third Central Hospital of Tianjin, Tianjin 300170, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China.
Exp Biol Med (Maywood). 2022 Sep;247(18):1657-1669. doi: 10.1177/15353702221113828. Epub 2022 Aug 10.
Brain metastasis (BM) is one of the rare metastatic sites of intrahepatic cholangiocarcinoma (ICC). ICC with BM can seriously affect the quality of life of patients and lead to a poor prognosis. The aim of this study was to establish two nomograms to estimate the risk of BM in ICC patients and the prognosis of ICC patients with BM. Data on 19,166 individuals diagnosed with ICC were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent risk factors and prognostic factors were identified by the logistic and the Cox regression, respectively. Next, two nomograms were developed, and their discrimination was estimated by concordance index (-index) and calibration plots, while the clinical benefits of the prognostic nomogram were evaluated using the receiver operating characteristic (ROC) curves, the decision curve analysis (DCA), and the Kaplan-Meier analyses. The independent risk factors for BM were T stage, N stage, surgery, alpha-fetoprotein (AFP) level, and tumor size. T stage, surgery, radiotherapy, and bone metastasis were prognostic factors for overall survival (OS). For the prognostic nomogram, the -index was 0.759 (95% confidence interval (CI) = 0.745-0.773) and 0.764 (95% CI = 0.747-0.781) in the training and the validation cohort, respectively. The calibration curves revealed a robust agreement between predictions and actual observations probability. The area under curves (AUCs) for the 3-, 6-, and 9-month OS were 0.721, 0.727, and 0.790 in the training cohort and 0.702, 0.777, and 0.853 in the validation cohort, respectively. The DCA curves yielded remarkable positive net benefits over a wide range of threshold probabilities. The Kaplan-Meier analysis illustrated that the nomogram could significantly distinguish the population with different survival risks. We successfully established the two nomograms for predicting the incidence of BM and the prognosis of ICC patients with BM, which may assist clinicians in choosing more effective treatment strategies.
脑转移（BM）是肝内胆管癌（ICC）罕见的转移部位之一。ICC 伴 BM 可严重影响患者的生活质量并导致预后不良。本研究旨在建立两个列线图来评估 ICC 患者发生 BM 的风险和 ICC 伴 BM 患者的预后。我们回顾性地从监测、流行病学和最终结果（SEER）数据库中收集了 19166 名诊断为 ICC 的个体的数据。通过逻辑回归和 Cox 回归分别确定了独立的风险因素和预后因素。接下来，我们开发了两个列线图，并通过一致性指数（-index）和校准图评估了它们的区分度，同时通过接受者操作特征（ROC）曲线、决策曲线分析（DCA）和 Kaplan-Meier 分析评估了预后列线图的临床获益。BM 的独立危险因素是 T 分期、N 分期、手术、甲胎蛋白（AFP）水平和肿瘤大小。T 分期、手术、放疗和骨转移是总生存（OS）的预后因素。对于预后列线图，训练队列和验证队列的 -index 分别为 0.759（95%置信区间（CI）=0.745-0.773）和 0.764（95%CI=0.747-0.781）。校准曲线显示预测值与实际观测概率之间存在稳健的一致性。训练队列中 3、6 和 9 个月 OS 的曲线下面积（AUC）分别为 0.721、0.727 和 0.790，验证队列中分别为 0.702、0.777 和 0.853。DCA 曲线在广泛的阈值概率范围内产生了显著的正净收益。Kaplan-Meier 分析表明，该列线图可显著区分具有不同生存风险的人群。我们成功建立了预测 ICC 患者 BM 发生率和预后的两个列线图，这可能有助于临床医生选择更有效的治疗策略。
