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The Limitations of Standard Clinicopathologic Features to Accurately Risk-Stratify Prognosis after Resection of Intrahepatic Cholangiocarcinoma

2018-03Journal article Open access
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dc.contributor.authorBagante, F
dc.contributor.authorMerath, K
dc.contributor.authorSquires, M
dc.contributor.authorWeiss, M
dc.contributor.authorAlexandrescu, S
dc.contributor.authorPinto Marques, H
dc.contributor.authorAldrighetti, L
dc.contributor.authorMaithel, S
dc.contributor.authorPulitano, C
dc.contributor.authorBauer, T
dc.contributor.authorShen, F
dc.contributor.authorPoultsides, G
dc.contributor.authorSoubrane, O
dc.contributor.authorMartel, G
dc.contributor.authorKoerkamp, B
dc.contributor.authorGuglielmi, A
dc.contributor.authorItaru, E
dc.contributor.authorPawlik, T
dc.date.accessioned2022-08-26T15:27:45Z
dc.date.available2022-08-26T15:27:45Z
dc.date.issued2018-03
dc.description.abstractBackground: The ability to provide accurate prognostic data after hepatectomy for intrahepatic cholangiocarcinoma (ICC) remains poor. We sought to develop and validate a nomogram to predict survival, as well as investigate the clinical implications of underestimating patients' risk of recurrence. Methods: Patients undergoing curative-intent resection of ICC between 1990 and 2015 at 14 major hepatobiliary centers were included. Variables significant on multivariable analysis were used to construct a nomogram to predict disease-free survival (DFS). The nomogram assigned a score to each variable included in the model and calculated the risk of recurrence. Results: Eight hundred ninety-seven patients are included in the analytic cohort. On multivariable Cox regression analysis, tumor size > 5 cm (HR 1.98, 95% CI 1.44-2.13; p < 0.001), multifocal ICC (HR 1.64, 95% CI 1.32-2.03; p < 0.001), lymph node metastasis (HR 1.63, 95% CI 1.25-2.11; p < 0.001), poorly differentiated tumor grade (HR 1.50, 95% CI 1.21-1.89; p < 0.001), and periductal infiltrating type (PI) morphology (HR 1.42, 95% CI 1.09-1.83; p = 0.008) were independent adverse risk factors associated with decreased DFS. The Harrell's c-index for the nomogram was 0.633 (with n = 5000 bootstrapping resamples) and the plot comparing predicted and actuarial DFS demonstrated a good calibration of the model. A subset of patients (n = 282) had a DFS worse than predicted (ΔPredicted DFS - Actuarial DFS > 6 months). Moreover, underestimation of a recurrence risk was more common among patients with clinicopathologic features traditionally considered "favorable." Conclusion: A nomogram based on standard clinicopathologic characteristics was suboptimal in its ability to predict accurately risk of recurrence among patients with ICC after curative-intent liver resection. Particularly, the risk of underestimating patient risk of recurrence was highest among patients with historically favorable characteristics. Over one third of patients recurred > 6 months earlier than the DFS predicted by the nomogram.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Gastrointest Surg . 2018 Mar;22(3):477-485pt_PT
dc.identifier.doi10.1007/s11605-018-3682-4.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4237
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHCC CIRpt_PT
dc.subjectAgedpt_PT
dc.subjectFemalept_PT
dc.subjectMalept_PT
dc.subjectHumanspt_PT
dc.subjectBile Duct Neoplasms / mortalitypt_PT
dc.subjectMiddle Agedpt_PT
dc.subjectBile Duct Neoplasms / pathology*pt_PT
dc.subjectBile Duct Neoplasms / surgery*pt_PT
dc.subjectCholangiocarcinoma / mortalitypt_PT
dc.subjectCholangiocarcinoma / pathology*pt_PT
dc.subjectCholangiocarcinoma / surgery*pt_PT
dc.subjectDisease-Free Survivalpt_PT
dc.subjectHepatectomypt_PT
dc.subjectLymphatic Metastasispt_PT
dc.subjectNeoplasm Gradingpt_PT
dc.subjectNeoplasm Recurrence, Local*pt_PT
dc.subjectNomograms*pt_PT
dc.subjectRisk Factorspt_PT
dc.subjectRisk Assessmentpt_PT
dc.titleThe Limitations of Standard Clinicopathologic Features to Accurately Risk-Stratify Prognosis after Resection of Intrahepatic Cholangiocarcinomapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage485pt_PT
oaire.citation.startPage477pt_PT
oaire.citation.titleJournal of Gastrointestinal Surgerypt_PT
oaire.citation.volume22pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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