Development and validation of a prognostic nomogram after hepatectomy for intrahepatic cholangiocarcinoma based on SEER database_Chinese Journal of Evidence-Based Medicine

Authors：

XIONG Zihui ¹ , TIAN Rui ¹ , CHENG Jie ¹ , LU Sili ¹ , PENG Jianxin ^1,2 ,  HE Junming ^1,2

1. The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
2. Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Traditional Chinese Medical, Guangzhou 510120, P. R. China;

Corresponding author：

HE Junming, Email: hejunming0101@sina.com

Keywords：

Intrahepatic cholangiocarcinoma; Hepatectomy; Nomogram

DOI：

10.7507/1672-2531.202304101

Video：

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Objective To develop and validate a nomogram for predicting the cancer-specific survival in patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy. Methods Suitable patient cases were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were established based on the independent prognostic factors identified by COX and Lasso regression models. The performance of the nomograms was validated internally and externally by using the concordance index (c-index), calibration plot, and decision curve analysis. Results The multi factor COX regression results showed that: age, gender, T stage, tumor grade, tumour diameter and number of positive lymph nodes were independent prognostic predictors for cancer-specific survival (CSS) in ICC patients. Nomogram predicting CSS had a c-index of 0.66 (95%CI 0.64 to 0.69) in the training cohort and 0.67 (95%CI 0.63 to 0.72) in the internal validation cohort. The 1-, 3- and 5-year areas under the curve (AUC) of nomogram were 0.68, 0.74 and 0.75 in the training cohort respectively. In the validation cohort, the 1-, 3- and 5-year AUC of nomogram were 0.69, 0.68 and 0.71, respectively. Conclusion The prediction model constructed based on six factors, including age, gender, pathological stage, T-stage, tumour diameter and number of positive lymph nodes, shows good prediction accuracy.

Citation： XIONG Zihui, TIAN Rui, CHENG Jie, LU Sili, PENG Jianxin, HE Junming. Development and validation of a prognostic nomogram after hepatectomy for intrahepatic cholangiocarcinoma based on SEER database. Chinese Journal of Evidence-Based Medicine, 2023, 23(10): 1129-1136. doi: 10.7507/1672-2531.202304101 Copy

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2.	Yang JD, Hainaut P, Gores GJ, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol, 2019, 16(10): 589-604.
3.	Shaib YH, Davila JA, McGlynn K, et al. Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase? J Hepatol, 2004, 40(3): 472-477.
4.	夏永祥, 张峰, 李相成, 等. 原发性肝癌10966例外科治疗分析. 中华外科杂志, 2021, 59(1): 6-17.
5.	Aljiffry M, Abdulelah A, Walsh M, et al. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg, 2009, 208(1): 134-147.
6.	Sharma R, Gibbs JF. Recent advances in the management of primary hepatic tumors refinement of surgical techniques and effect on outcome. J Surg Oncol, 2010, 101(8): 745-754.
7.	Chun YS, Pawlik TM, Vauthey JN. 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol, 2018, 25(4): 845-847.
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9.	Yuan L, Luo X, Lu X, et al. Liver resection for intrahepatic cholangiocarcinoma in AJCC-stage Ⅳ: an evaluation of the survival benefit and prognostic accuracy of current AJCC staging system on N and M classification. Oncol Rep, 2016, 36(5): 2663-2672.
10.	Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
11.	谢同辉, 陈志强, 常建华, 等. 肝内胆管癌根治性切除术后生存因素分析及列线图的建立. 山东大学学报(医学版), 2021, 59(4): 93-99.
12.	吴志平, 张一帆, 邓信朗, 等. 肝内胆管癌根治术后生存的列线图预测模型. 中华普通外科学文献(电子版), 2020, 14(2): 141-146.
13.	Kelley RK, Bridgewater J, Gores GJ, et al. Systemic therapies for intrahepatic cholangiocarcinoma. J Hepatol, 2020, 72(2): 353-363.
14.	Kim Y, Moris DP, Zhang XF, et al. Evaluation of the 8th edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: a surveillance, epidemiology, and end results (SEER) analysis. J Surg Oncol, 2017, 116(6): 643-650.
15.	Zhang Y, Wu Z, Wang X, et al. Development and external validation of a nomogram for predicting the effect of tumor size on survival of patients with perihilar cholangiocarcinoma. BMC Cancer, 2020, 20(1): 1044.
16.	Thuret R, Sun M, Abdollah F, et al. Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma. J Urol, 2011, 185(2): 501-507.
17.	Xing H, Tan B, Yang C, et al. Incidence trend and competing risk analysis of patients with intrahepatic cholangiocarcinoma: a population-based study. Front Med (Lausanne), 2022, 9: 846276.
18.	李斌, 姜小清. 肝切除术式合理决策要点. 中国实用外科杂志, 2022, 42(12): 1416-1420.
19.	倪俊声, 周伟平. 以切缘为本的肝切除是提高原发性肝癌生存率的关键. 肝胆外科杂志, 2020, 28(2): 87-90.
20.	Lang H, Sotiropoulos GC, Frühauf NR, et al. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg, 2005, 241(1): 134-143.
21.	Sotiropoulos GC, Bockhorn M, Sgourakis G, et al. R0 liver resections for primary malignant liver tumors in the noncirrhotic liver: a diagnosis-related analysis. Dig Dis Sci, 2009, 54(4): 887-894.
22.	Zhang XF, Bagante F, Chakedis J, et al. Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy. J Gastrointest Surg, 2017, 21(11): 1841-1850.
23.	Benson AB, D'Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(5): 541-565.
24.	Lee AJ, Chun YS. Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates. Chin Clin Oncol, 2018, 7(5): 52.
25.	de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol, 2011, 29(23): 3140-3145.
26.	Li DY, Zhang HB, Yang N, et al. Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients: results of a monocentric series. World J Gastroenterol, 2013, 19(47): 9084-9091.
27.	Kim DH, Choi DW, Choi SH, et al. Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution. Surgery, 2015, 157(4): 666-675.

1. Banales JM, Marin JJG, Lamarca A, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol, 2020, 17(9): 557-588.
2. Yang JD, Hainaut P, Gores GJ, et al. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol, 2019, 16(10): 589-604.
3. Shaib YH, Davila JA, McGlynn K, et al. Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase? J Hepatol, 2004, 40(3): 472-477.
4. 夏永祥, 张峰, 李相成, 等. 原发性肝癌10966例外科治疗分析. 中华外科杂志, 2021, 59(1): 6-17.
5. Aljiffry M, Abdulelah A, Walsh M, et al. Evidence-based approach to cholangiocarcinoma: a systematic review of the current literature. J Am Coll Surg, 2009, 208(1): 134-147.
6. Sharma R, Gibbs JF. Recent advances in the management of primary hepatic tumors refinement of surgical techniques and effect on outcome. J Surg Oncol, 2010, 101(8): 745-754.
7. Chun YS, Pawlik TM, Vauthey JN. 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol, 2018, 25(4): 845-847.
8. Forner A, Vidili G, Rengo M, et al. Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver Int, 2019, 39(Suppl 1): 98-107.
9. Yuan L, Luo X, Lu X, et al. Liver resection for intrahepatic cholangiocarcinoma in AJCC-stage Ⅳ: an evaluation of the survival benefit and prognostic accuracy of current AJCC staging system on N and M classification. Oncol Rep, 2016, 36(5): 2663-2672.
10. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
11. 谢同辉, 陈志强, 常建华, 等. 肝内胆管癌根治性切除术后生存因素分析及列线图的建立. 山东大学学报(医学版), 2021, 59(4): 93-99.
12. 吴志平, 张一帆, 邓信朗, 等. 肝内胆管癌根治术后生存的列线图预测模型. 中华普通外科学文献(电子版), 2020, 14(2): 141-146.
13. Kelley RK, Bridgewater J, Gores GJ, et al. Systemic therapies for intrahepatic cholangiocarcinoma. J Hepatol, 2020, 72(2): 353-363.
14. Kim Y, Moris DP, Zhang XF, et al. Evaluation of the 8th edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: a surveillance, epidemiology, and end results (SEER) analysis. J Surg Oncol, 2017, 116(6): 643-650.
15. Zhang Y, Wu Z, Wang X, et al. Development and external validation of a nomogram for predicting the effect of tumor size on survival of patients with perihilar cholangiocarcinoma. BMC Cancer, 2020, 20(1): 1044.
16. Thuret R, Sun M, Abdollah F, et al. Tumor grade improves the prognostic ability of American Joint Committee on Cancer stage in patients with penile carcinoma. J Urol, 2011, 185(2): 501-507.
17. Xing H, Tan B, Yang C, et al. Incidence trend and competing risk analysis of patients with intrahepatic cholangiocarcinoma: a population-based study. Front Med (Lausanne), 2022, 9: 846276.
18. 李斌, 姜小清. 肝切除术式合理决策要点. 中国实用外科杂志, 2022, 42(12): 1416-1420.
19. 倪俊声, 周伟平. 以切缘为本的肝切除是提高原发性肝癌生存率的关键. 肝胆外科杂志, 2020, 28(2): 87-90.
20. Lang H, Sotiropoulos GC, Frühauf NR, et al. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg, 2005, 241(1): 134-143.
21. Sotiropoulos GC, Bockhorn M, Sgourakis G, et al. R0 liver resections for primary malignant liver tumors in the noncirrhotic liver: a diagnosis-related analysis. Dig Dis Sci, 2009, 54(4): 887-894.
22. Zhang XF, Bagante F, Chakedis J, et al. Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy. J Gastrointest Surg, 2017, 21(11): 1841-1850.
23. Benson AB, D'Angelica MI, Abbott DE, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2021, 19(5): 541-565.
24. Lee AJ, Chun YS. Intrahepatic cholangiocarcinoma: the AJCC/UICC 8th edition updates. Chin Clin Oncol, 2018, 7(5): 52.
25. de Jong MC, Nathan H, Sotiropoulos GC, et al. Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol, 2011, 29(23): 3140-3145.
26. Li DY, Zhang HB, Yang N, et al. Routine lymph node dissection may be not suitable for all intrahepatic cholangiocarcinoma patients: results of a monocentric series. World J Gastroenterol, 2013, 19(47): 9084-9091.
27. Kim DH, Choi DW, Choi SH, et al. Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution. Surgery, 2015, 157(4): 666-675.

Chinese Journal of Evidence-Based Medicine

Development and validation of a prognostic nomogram after hepatectomy for intrahepatic cholangiocarcinoma based on SEER database

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