Zhu Shan-Fei, Mao Ben-Liang, Zhuang Run-Yu, Huang Jie-Yu, Wu Fan, Wang Bai-Lin, Yan Yong
Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
College of Clinical Medicine, Guizhou Medical University, Guiyang, China.
Transl Cancer Res. 2024 Aug 31;13(8):4010-4027. doi: 10.21037/tcr-24-567. Epub 2024 Aug 27.
Bone metastasis (BM) is a common site of metastasis in patients with intrahepatic cholangiocarcinoma (ICC), significantly impacting the quality of life and prognosis of affected individuals. This investigation aimed to assess the risk of BM development in ICC patients and to prognosticate for patients with ICC-associated BM (ICCBM) through the construction of two nomograms.
We conducted a retrospective analysis of data from 2,651 ICC patients, including 148 cases of BM, documented in the Surveillance, Epidemiology, and End Results (SEER) database spanning 2010 to 2017. Independent predictors for the occurrence of BM in ICC patients were identified via univariate and multivariate logistic regression analyses; simultaneously, independent prognostic indicators for ICCBM patients were ascertained through univariate and multivariate Cox regression analyses. The utility of the nomograms was evaluated through calibration curves, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and Kaplan-Meier (KM) analysis.
Independent risk factors for BM in ICC included sex, tumor size, lung metastasis, brain metastasis, and intrahepatic metastasis. For ICCBM patients, independent prognostic factors comprised age, chemotherapy, and radiotherapy. The prognostic nomogram exhibited C-indexes of 0.737 [95% confidential interval (CI): 0.682-0.792] for the training cohort and 0.696 (95% CI: 0.623-0.769) for the validation cohort. Calibration curves demonstrated strong concordance between predicted outcomes and observed events. The areas under the curve (AUC) for 3-, 6-, and 12-month cancer-specific survival (CSS) were 0.853, 0.781, and 0.739, respectively, in the training cohort, and 0.794, 0.822, and 0.780 in the validation cohort. DCA illustrated significant net benefits across a broad spectrum of threshold probabilities. KM analysis revealed 1-, 2-, and 3-year CSS rates of 23.91%, 7.55%, and 2.35%, respectively, with a median CSS of 6 months, underscoring the nomograms' capacity to distinctly stratify patients according to survival risk.
The development of these nomograms offers substantial clinical utility in forecasting BM risk among ICC patients and prognosticating for those with ICCBM, thereby facilitating the formulation of more efficacious treatment modalities.
骨转移（BM）是肝内胆管癌（ICC）患者常见的转移部位，严重影响患者的生活质量和预后。本研究旨在通过构建两个列线图来评估ICC患者发生BM的风险，并对ICC相关骨转移（ICCBM）患者进行预后预测。
我们对监测、流行病学和最终结果（SEER）数据库中2010年至2017年记录的2651例ICC患者的数据进行了回顾性分析，其中包括148例BM患者。通过单因素和多因素逻辑回归分析确定ICC患者发生BM的独立预测因素；同时，通过单因素和多因素Cox回归分析确定ICCBM患者的独立预后指标。通过校准曲线、受试者操作特征（ROC）曲线、决策曲线分析（DCA）和Kaplan-Meier（KM）分析评估列线图的效用。
ICC患者发生BM的独立危险因素包括性别、肿瘤大小、肺转移、脑转移和肝内转移。对于ICCBM患者，独立预后因素包括年龄、化疗和放疗。预后列线图在训练队列中的C指数为0.737[95%置信区间（CI）：(0.682 - 0.792)]，在验证队列中的C指数为0.696（95%CI：(0.623 - 0.769)）。校准曲线显示预测结果与观察到的事件之间具有很强的一致性。训练队列中3个月、6个月和12个月癌症特异性生存率（CSS）的曲线下面积（AUC）分别为0.853、0.781和0.739，验证队列中分别为0.794、0.822和0.780。DCA显示在广泛的阈值概率范围内有显著的净效益。KM分析显示1年、2年和3年CSS率分别为23.91%、7.55%和2.35%，CSS中位数为6个月，突出了列线图根据生存风险对患者进行明确分层的能力。
这些列线图的开发在预测ICC患者的BM风险和对ICCBM患者进行预后预测方面具有重要的临床应用价值，从而有助于制定更有效的治疗方案。
