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. 2020 Apr 2:10:434.
doi: 10.3389/fonc.2020.00434. eCollection 2020.

A Novel Prognostic Nomogram for Patients With Recurrence of Intrahepatic Cholangiocarcinoma After Initial Surgery

Kai-Li Xing  1   2   3 , Liang-He Lu  2   3   4 , Xin Huang  1   2   3 , Chao-Bin He  1   2   3 , Yun-Da Song  1   2   3 , Rong-Ping Guo  2   3   4 , Sheng-Ping Li  1   2   3
Affiliations

A Novel Prognostic Nomogram for Patients With Recurrence of Intrahepatic Cholangiocarcinoma After Initial Surgery

Kai-Li Xing et al. Front Oncol. .

Abstract

Background: The prognosis of patients with post-operative recurrent intrahepatic cholangiocarcinoma (ICC) is at great variance. We aimed to propose a novel efficient prognostic nomogram in facilitating the risk stratification for post-operative recurrent ICC patients. Methods: From 2000 to 2016, a total of 237 post-operative recurrent ICC patients were enrolled in this study, and randomly divided into training (n = 178) and validation cohorts (n = 59) at a ratio of 3:1. The performance of this nomogram was assessed by discrimination, calibration, and clinical usefulness, and the results were compared with four other currently used ICC staging systems. Results: On multivariate analysis of the training cohort, serum CA 19-9, albumin-bilirubin grade at recurrence, time from primary resection to recurrence, tumor number at recurrence, and treatment for recurrence were selected for the model. The concordance index (C-index) of our model was 0.791 [95% confidence interval (CI), 0.736-0.846], which was statistically higher than the values of the following systems: American Joint Committee on Cancer (AJCC) 8th edition (0.610), Liver Cancer Study Group of Japan (0.613), Nathan (0.582), and Okabayashi (0.600; P < 0.001 for all). The nomogram performed well in terms of calibration when compared with actual observation. The findings were supported by the validation cohort. Conclusions: Compared with four currently used staging systems for ICC, our nomogram showed more promising clinical utility in improving individualized predictions of survival for post-operative recurrent ICC patients.

Keywords: intrahepatic cholangiocarcinoma; nomogram; post-recurrence survival; recurrence; resection.

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Figures

Figure 1
Figure 1
Nomogram for predicting the 1 and 3 years post-recurrence survival rates in patients with post-operative recurrence of intrahepatic cholangiocarcinoma.
Figure 2
Figure 2
The calibration curve for predicting patient survival at (A) 1 year and (B) 3 years in the training cohort and at (C) 1 year in the validation cohort. Nomogram-predicted probability of overall survival is plotted on the x-axis; actual overall survival is plotted on the y-axis.
Figure 3
Figure 3
Kaplan-Meier survival curves categorized by different staging systems: the training cohort: [(A) American Joint Committee on Cancer (AJCC) 8th edition; (B) Nathan; (C) Okabayashi; (D) Liver Cancer Study Group of Japan (LCSGJ); (E) our nomogram]; the validation cohort: [(F) AJCC 8th edition; (G) Nathan; (H) Okabayashi; (I) LCSGJ; (J) our nomogram].
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