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Defining When to Offer Operative Treatment for Intrahepatic Cholangiocarcinoma: A Regret-Based Decision Curves Analysis

2016Journal article Open access
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dc.contributor.authorBagante, F
dc.contributor.authorSpolverato, G
dc.contributor.authorCucchetti, A
dc.contributor.authorGani, F
dc.contributor.authorPopescu, I
dc.contributor.authorRuzzenente, A
dc.contributor.authorPinto Marques, H
dc.contributor.authorAldrighetti, L
dc.contributor.authorGamblin, T
dc.contributor.authorMaithel, S
dc.contributor.authorSandroussi, C
dc.contributor.authorBauer, T
dc.contributor.authorShen, F
dc.contributor.authorPoultsides, G
dc.contributor.authorMarsh, J
dc.contributor.authorGuglielmi, A
dc.contributor.authorPawlik, T
dc.date.accessioned2018-11-29T16:01:29Z
dc.date.available2018-11-29T16:01:29Z
dc.date.issued2016
dc.description.abstractBACKGROUND: 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).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationSurgery. 2016 Jul;160(1):106-117.pt_PT
dc.identifier.doi10.1016/j.surg.2016.01.023pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3114
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectAgedpt_PT
dc.subjectBile Duct Neoplasmspt_PT
dc.subjectCholangiocarcinomapt_PT
dc.subjectDecision Support Techniquespt_PT
dc.subjectEmotionspt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectNomogramspt_PT
dc.subjectSurvival Ratept_PT
dc.subjectAttitude of Health Personnelpt_PT
dc.subjectBile Ducts, Intrahepaticpt_PT
dc.subjectClinical Decision-Makingpt_PT
dc.subjectHepatectomypt_PT
dc.subjectHCC CIRpt_PT
dc.titleDefining When to Offer Operative Treatment for Intrahepatic Cholangiocarcinoma: A Regret-Based Decision Curves Analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage117pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPage106pt_PT
oaire.citation.titleSurgerypt_PT
oaire.citation.volume160pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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