Bagante, FMerath, KSquires, MWeiss, MAlexandrescu, SPinto Marques, HAldrighetti, LMaithel, SPulitano, CBauer, TShen, FPoultsides, GSoubrane, OMartel, GKoerkamp, BGuglielmi, AItaru, EPawlik, T2022-08-262022-08-262018-03J Gastrointest Surg . 2018 Mar;22(3):477-485http://hdl.handle.net/10400.17/4237Background: 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.engHCC CIRAgedFemaleMaleHumansBile Duct Neoplasms / mortalityMiddle AgedBile Duct Neoplasms / pathology*Bile Duct Neoplasms / surgery*Cholangiocarcinoma / mortalityCholangiocarcinoma / pathology*Cholangiocarcinoma / surgery*Disease-Free SurvivalHepatectomyLymphatic MetastasisNeoplasm GradingNeoplasm Recurrence, Local*Nomograms*Risk FactorsRisk Assessmentjournal article10.1007/s11605-018-3682-4.