Screening and identification of the beneficiaries of adjuvant chemotherapy based on the prognostic model of intrahepatic cholangiocarcinoma

doi:10.16139/j.1007-9610.2024.02.13

Abstract

Abstract:

Objective To establish and validate a Nomogram model for predicting the overall survival (OS) of the patients with intrahepatic cholangiocarcinoma (ICC) based on domestic multicenter data, and screen the beneficiaries of adjuvant chemotherapy based on the prediction model. Methods From December 2011 to December 2017, the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model. This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy. Results A total of 278 patients were enrolled, and 23 cases(8.3%) received adjuvant chemotherapy. COX multivariate analysis showed that drinking history, ECOG score, method of hepatectomy, lymph node status, number of tumors, and tumor differentiation were independent risk factors for postoperative OS. The Nomogram model had a C-index of 0.690(95% CI: 0.646-0.734) in the training cohort and 0.740(95% CI: 0.863-0.617) in the validation cohort. According to risk stratification by Nomogram model, in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy (P=0.033), whereas in the low-risk group, there was no significant difference in survival(P=0.59). Conclusion Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen, and identify the patients with ICC who benefit from adjuvant chemotherapy.

Key words: Intrahepatic cholangiocarcinoma(ICC), Nomogram, Adjuvant chemotherapy, Prognosis, Multicenter

CLC Number:

R735.7

LIN Qizhu, LIU Hongzhi, HUANG Tingfeng, FAN Ruilin, ZHOU Weiping, ZHENG Shuguo, LOU Jianying, ZENG Yongyi. Screening and identification of the beneficiaries of adjuvant chemotherapy based on the prognostic model of intrahepatic cholangiocarcinoma[J]. Journal of Surgery Concepts & Practice, 2024, 29(02): 170-178.

Figures/Tables 7

Tab 1

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Tab 2

Clinical and pathological data in ICC patients afterradical resection with and without adjuvant chemotherapy[n(%)]

Characteristics	Group	Non- chemotherapy(n=255)	Chemotherapy(n=23)	P value
Gender	Man	165 (64.71)	15 (65.22)	1
	Woman	90 (35.29)	8 (34.78)
Age (year)	≤60	149 (58.43)	16 (69.57)	0.412 5
	>60	106 (41.57)	7 (30.43)
Smoking history	No	167 (65.49)	16 (69.57)	0.868 8
	Yes	88 (34.51)	7 (30.43)
Drinking history	No	206 (80.78)	22 (95.65)	0.135
	Yes	49 (19.22)	1 (4.35)
HBV	No	97 (38.04)	6 (26.09)	0.362 1
	Yes	158 (61.96)	17 (73.91)
ECOG score	≤2	206 (80.78)	22 (95.65)	0.135
	>2	49 (19.22)	1 (4.35)
CA19-9 (U/mL)	≤37	190 (74.51)	10 (43.48)	0.003 4
	>37	65 (25.49)	13 (56.52)
CEA (μg/L)	≤5	216 (84.71)	13 (56.52)	0.001 9
	>5	39 (15.29)	10 (43.48)
TBIL (μmol/L)	≤20	128 (50.20)	10 (43.48)	0.689 6
	>20	127 (49.80)	13 (56.52)
Blood loss (mL)	≤400	212 (83.14)	13 (56.52)	0.004 6
	>400	43 (16.86)	10 (43.48)
Blood transfusion	No	220 (86.27)	17 (73.91)	0.195 6
	Yes	35 (13.73)	6 (26.09)
Margin (cm)	<1	184 (72.16)	3 (13.04)	<0.000 1
	≥1	71 (27.84)	20 (86.96)
Method of hepatectomy	Anatomical	103 (40.39)	11 (47.83)	0.636 3
	Non-anatomical	152 (59.61)	12 (52.17)
LND	No	201 (78.82)	7 (30.43)	<0.000 1
	Yes	54 (21.18)	16 (69.57)
Lymph node status	Nx	201 (78.82)	7 (30.43)	<0.000 1
	N0	33 (12.94)	6 (26.09)
	N1	21 (8.24)	10 (43.48)
Gross classification	MF	156 (61.18)	20 (86.96)	0.025 7
	Non-MF	99 (38.82)	3 (13.04)
Histological classification	Adenocarcinoma	238 (93.33)	23 (100.00)	0.410 1
	Non-adenocarcinoma	17 (6.67)	0
Tumor differentiation	Well &Moderate	225 (88.24)	12 (52.17)	<0.000 1
	Poor	30 (11.76)	11 (47.83)
Number of tumors	Single	180 (70.59)	22 (95.65)	0.019 3
	Multiple	75 (29.41)	1 (4.35)
Tumor maximum diameter (cm)	≤5	94 (36.86)	8 (34.78)	1
	>5	161 (63.14)	15 (65.22)
MVI	No	218 (85.49)	11 (47.83)	<0.000 1
	Yes	37 (14.51)	12 (52.17)
Complications	No	218 (85.49)	16 (69.57)	0.088 1
	Yes	37 (14.51)	7 (30.43)

Tab 2

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		Univariate analysis			Multivariate analysis
		HR	95%CI	P value	HR	95%CI	P value
Gender	Woman vs. Man	0.82	0.57-1.19	0.3
Age(years)	>60 vs. ≤60	0.98	0.7-1.37	0.897
Smoking history	Yes vs. No	1.13	0.8-1.59	0.48
Drinking history	Yes vs. No	2.26	1.51-3.38	<0.001	2.49	1.65-3.77	<0.001
HBV	Yes vs. No	1.19	0.85-1.67	0.304
ECOG score	>2 vs. ≤2	1.7	1.16-2.49	0.007	1.46	0.98-2.16	0.048 7
CA19-9（U/mL）	>37 vs. ≤37	1.79	1.22-2.63	0.003	1.42	0.95-2.13	0.091 1
CEA(μg/L)	>5 vs. ≤5	1.46	0.9-2.37	0.128
TBIL(μmol/L)	>20 vs. ≤20	0.94	0.68-1.31	0.725
Blood loss	>400 vs. ≤400	1.05	0.66-1.69	0.828
Blood transfusion	Yes vs. No	1.4	0.8-2.43	0.234
Margin(cm)	≥1 vs. <1	0.71	0.41-1.21	0.205
Method of hepatectomy	Non-anatomical vs. Anatomical	0.64	0.45-0.89	0.009	0.7	0.49-0.99	0.042
LND	Yes vs. No	1.41	0.9-2.19	0.132
Lymph node status	N0 vs. Nx	0.9	0.5-1.63	0.728
	N1 vs. Nx	3.3	1.8-6.03	<0.001	2.6	1.36-4.98	0.003 9
Gross classification	Non-MF(mass forming) vs. MF	1.31	0.94-1.82	0.111
Histological classification	Non-adenocarcinoma vs. Adenocarcinoma	0.47	0.21-1.05	0.067
Tumor differentiation	Poor vs. Well &moderate	1.88	1.12-3.17	0.017	2.28	1.31-3.95	0.003 5
Number of tumors	Multiple vs. Single	1.72	1.22-2.42	0.002	1.48	1.02-2.14	0.038 2
Tumor maximum diameter (cm)	>5 vs. ≤5	1.53	1.07-2.21	0.021	1.37	0.94-2	0.096 7
MVI	Yes vs. No	1.2	0.75-1.93	0.444
Complications	Yes vs. No	1.5	0.93-2.41	0.093