Development and external validation of a prognosis model to predict outcomes after curative resection of early-stage intrahepatic cholangiocarcinoma

Jianping Wang; Manling Huang; Jingxian Shen; Bin Li; Yanqing Wu; Wenxuan Xie; Han Xiao; Li Tan

doi:10.3389/fsurg.2023.1102871

Development and external validation of a prognosis model to predict outcomes after curative resection of early-stage intrahepatic cholangiocarcinoma

Front Surg. 2023 Mar 8:10:1102871. doi: 10.3389/fsurg.2023.1102871. eCollection 2023.

Authors

Jianping Wang¹, Manling Huang^{2

3}, Jingxian Shen⁴, Bin Li⁵, Yanqing Wu¹, Wenxuan Xie⁶, Han Xiao⁷, Li Tan^{3

5

6}

Affiliations

¹ Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
² Department of Oncology, Cancer Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
³ Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁴ Department of Medical Imaging, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, China.
⁵ Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁶ Center of Hepato-Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
⁷ Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

Abstract

Background: Early-stage intrahepatic cholangiocarcinoma (ESICC) with curative resection and lymph node-negative still has the risk of poor prognosis, and there lacks prognosis-assessing tools for these patients. The objective of this study was to develop a prognosis model to predict outcomes and identify risk stratification for ESICC after resection.

Methods: Totally 263 patients with ESICC after hepatectomy from January 2012 to January 2022 were analyzed. Clinicopathological factors were selected using multivariable Cox regression analysis and a prognosis model was developed. The performance of the model was evaluated by concordance index (C-index), calibration plots, decision curves analysis (DCA), and net reclassification index (NRI). Kaplan-Meier curves were analyzed for risk stratification of overall survival (OS) and recurrence-free survival (RFS) based on the prognosis model.

Results: The clinicopathological features that were independently associated with OS of ESICC included carbohydrate antigen19-9, carcinoembryonic antigen, tumor size, tumor differentiation, and T stage. The prognosis model based on these prognostic factors demonstrated excellent discriminatory performance in both derivation cohort (C-index, 0.71) and external validation cohort (C-index, 0.78), which outperformed the TNM staging system (C-index, 0.59) and individual prognostic factors (all C-index < 0.7). Calibration plots, DCA and NRI also showed superior predictive performance. According to the risk for survival, the model stratified patients into low risk (median OS, 66.6 months; median RFS, 24.3 months) and high risk (median OS, 24.0 months; median RFS, 6.4 months) (P < 0.001).

Conclusions: Our prognosis model can robustly predict the outcomes of ESICC after curative resection and provide precise evaluation on prognosis risk, facilitating clinicians to develop individualized postoperative treatment options.

Keywords: intrahepatic cholangiocarcinoma; nomogram; prognosis; resection; risk.

Grants and funding

The work was supported by the National Natural Science Foundation of China (No. 82203083), the China Postdoctoral Science Foundation (No. 2021M703713), and the Guangzhou Basic and Applied Basic Research Project (No. 202102020052)