A carregar...
Publicação
Defining When to Offer Operative Treatment for Intrahepatic Cholangiocarcinoma: A Regret-Based Decision Curves Analysis
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 621.52 KB | Adobe PDF |
Orientador(es)
Resumo(s)
BACKGROUND:
Regret-based decision curve analysis (DCA) is a framework that assesses the medical decision process according to physician attitudes (expected regret) relative to disease-based factors. We sought to apply this methodology to decisions around the operative management of intrahepatic cholangiocarcinoma (ICC).
METHODS:
Utilizing a multicentric database of 799 patients who underwent liver resection for ICC, we developed a prognostic nomogram. DCA tested 3 strategies: (1) perform an operation on all patients, (2) never perform an operation, and (3) use the nomogram to select patients for an operation.
RESULTS:
Four preoperative variables were included in the nomogram: major vascular invasion (HR = 1.36), tumor number (multifocal, HR = 1.18), tumor size (>5 cm, HR = 1.45), and suspicious lymph nodes on imaging (HR = 1.47; all P < .05). The regret-DCA was assessed using an online survey of 50 physicians, expert in the treatment of ICC. For a patient with a multifocal ICC, largest lesion measuring >5 cm, one suspicious malignant lymph node, and vascular invasion on imaging, the 1-year predicted survival was 52% according to the nomogram. Based on the therapeutic decision of the regret-DCA, 60% of physicians would advise against an operation for this scenario. Conversely, all physicians recommended an operation to a patient with an early ICC (single nodule measuring 3 cm, no suspicious lymph nodes, and no vascular invasion at imaging).
CONCLUSION:
By integrating a nomogram based on preoperative variables and a regret-based DCA, we were able to define the elements of how decisions rely on medical knowledge (postoperative survival predicted by a nomogram, severity disease assessment) and physician attitudes (regret of commission and omission).
Descrição
Palavras-chave
Aged Bile Duct Neoplasms Cholangiocarcinoma Decision Support Techniques Emotions Female Humans Male Middle Aged Nomograms Survival Rate Attitude of Health Personnel Bile Ducts, Intrahepatic Clinical Decision-Making Hepatectomy HCC CIR
Contexto Educativo
Citação
Surgery. 2016 Jul;160(1):106-117.