J Cancer 2020; 11(19):5623-5634. doi:10.7150/jca.46587

Research Paper

Developing a Selection-aided Model to Screen Cirrhotic Intrahepatic Cholangiocarcinoma for Hepatectomy

Qinjunjie Chen1*, Fengwei Li1,2*, Yuzhen Gao3*, Hui Xue2, Zheng Li1, Qifei Zou2, Yong Xia1, Kui Wang2✉, Feng Shen1✉

1. Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
2. Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
3. Department of Molecular Diagnosis, Clinical Medical College, Yangzhou University, Jiangsu, China.
*These authors contributed equally to this work.

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Citation:
Chen Q, Li F, Gao Y, Xue H, Li Z, Zou Q, Xia Y, Wang K, Shen F. Developing a Selection-aided Model to Screen Cirrhotic Intrahepatic Cholangiocarcinoma for Hepatectomy. J Cancer 2020; 11(19):5623-5634. doi:10.7150/jca.46587. Available from http://www.jcancer.org/v11p5623.htm

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Abstract

Background: This study aimed to establish a model predicting the prognosis of intrahepatic cholangiocarcinoma (ICC) patients with cirrhosis before liver resection (LR).

Methods: An Eastern Hepatobiliary Surgery Hospital (EHBH) model using the preoperative factors was established in a training cohort (305 patients from 2006 to 2011) and validated in an internal validation cohort (113 patients from 2012 to 2014). Predictive performance and discrimination were evaluated and compared with other staging systems.

Results: The EHBH model containing preoperative factors of carbohydrate antigen 19-9 (CA19-9), radiological tumor diameter, tumor number, and satellite nodules outperformed other staging systems in predicting the prognosis of ICC. A contour plot of 3-year survival probability and a nomogram to form two differentiated groups of patients (high-risk group and low-risk group) were constructed based on the EHBH model to help surgeons predicting the overall survival (OS) before LR. Patients from the high-risk group (>86.56 points) in the training cohort had worse OS rates compared with those from the low-risk group (≤86.56 points). The one-, three-, and five-year OS rates were 50.4%, 29.0%, and 21.0% for the high-risk group and 68.2%, 45.5%, and 39.7% for the low-risk group, respectively (P<0.001). The same results were obtained in the internal validation patients.

Conclusion: The contour plot is an easy-to-use tool to individually show the 3-year prognosis of ICC patients with different preoperative CA19-9 values and radiological characteristics before surgery. The EHBH model was suitable for selecting cirrhotic patients for LR to acquire a better survival.

Keywords: intrahepatic cholangiocarcinoma, cirrhosis, liver resection, prognosis