Ann Surg Treat Res.  2024 Jul;107(1):16-26. 10.4174/astr.2024.107.1.16.

A personalized prognostic model for long-term survival in patients with intrahepatic cholangiocarcinoma: a retrospective cohort study

• Dong X
• Zhang P
• Ye C
• Li L

• KMID: 2557576
• DOI: http://doi.org/10.4174/astr.2024.107.1.16

Abstract

Purpose
This study aimed to determine the optimal cutoff points for age and tumor size of patients with intrahepatic cholangiocarcinoma (ICC) and to establish and verify a predictive nomogram of overall survival at 1, 3, and 5 years.
Methods
From the SEER (Surveillance, Epidemiology, and End Results) database, 1,325 ICC patients were selected and randomly divided into training and testing cohorts at a 7:3 ratio. Using the X-tile software, age and tumor size were classified into 3 subgroups: ≤61, 62–74, and ≥75 years and ≤35, 36–55, and ≥56 mm. Subsequently, univariate and multivariate Cox regression analyses were performed using the R software in the training cohort to determine independent risk factors, compile the prediction nomogram, and verify it with the testing cohort findings.
Results
The C-indexes of the new prediction nomograms in the training and testing cohorts were 0.738 (95% confidence interval [CI], 0.718–0.758) and 0.750 (95% CI, 0.72–0.78), respectively. Furthermore, the areas under the 1-, 3-, and 5-year receiver operating characteristic (ROC) curves based on the nomogram were 0.792, 0.853, and 0.838, respectively, higher than the ROC based on the 7th and 8th editions of the American Joint Cancer Commission (AJCC) staging system.
Conclusion
This study established and verified a prognostic nomogram that improved the accuracy of the 1-, 3-, and 5-year survival predictions for ICC patients, compared with that based on the 7th and 8th editions of the AJCC staging system, and can help clinicians make personalized survival predictions.

Keyword

Cholangiocarcinoma; Nomograms; Survival; Neoplasms

Figure

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  Fig. 1 Flowchart displaying the extraction and grouping process of resected intrahepatic cholangiocarcinoma (ICC) cases in the SEER (the Surveillance, Epidemiology, and End Results) database. ICD-O-3, International Classification of Diseases for Oncology, the 3rd edition; WHO, World Health Organization; TNM7, the 7th edition of the American Joint Cancer Commission TNM classification (2010).

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  Fig. 2 X-tile analysis of the patient’s age and tumor size. (A) The best age cutoff points. (B) The best tumor size cutoff points.

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  Fig. 3 Forest plot of hazard ratio of independent prognostic factors for overall survival of intrahepatic cholangiocarcinoma patients.

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  Fig. 4 The Kaplan-Meier curves of overall survival rates stratified by patient characteristics. (A) race, (B) sex, (C) grade, (D) T stage, (E) N stage, (F) M stage, (G) surgery, (H) size, and (I) age.

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  Fig. 5 The nomogram contains independent prognostic factors for the 1- , 3- , and 5-year overall survival of intrahepatic cholangiocarcinoma patients.

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  Fig. 6 The receiver operating characteristic (ROC) curves of the nomogram and TNM stage for predicting prognosis in the training and testing cohorts. (A–C) The area under the ROC curve (AUC) of overall survival (OS) in the training cohort at 1 year (A), 3 years (B), and 5 years (C). (D–F) ROC of OS in the testing cohort at 1 year (D), 3 years (E), and 5 years (F).

• 

  Fig. 7 Calibration plot of the 1-, 3-, and 5-year overall survival (OS) nomogram in the training (A–C) and testing cohorts (D–F).

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