Nomogram model for the prognosis of intrahepatic cholangiocarcinoma after radical resection

doi:10.3877/cma.j.issn.1674-0793.2020.02.016

Abstract

Abstract:

Objective

To investigate the factors influencing the prognosis and survival of patients with intrahepatic cholangiocarcinoma (ICC), and to construct a nomogram to predict the patient’s overall survival (OS) individually.

Methods

A retrospective analysis was performed in two hundred and sixty-three ICC patients who underwent radical hepatectomy from January 2008 to December 2017 in the First Affiliated Hospital of Sun Yat-sen University. Univariate and multivariate Cox proportional hazard regression methods were used to screen the independent influencing factors of the OS of patients, and then to construct the nomogram to individually predict the survival of patients after ICC radical surgery. The potential correlation between pre-albumin and clinical characteristics of ICC patients were also investigated with density mapping.

Results

The median follow-up period of the 263 patients was 30 (1-118) months, and the OS was 11 (0.5-118) months. The 1, 2, and 3-year cumulative survival rates were 55.0%, 40.2%, and 27.5%, respectively. Univariate and multivariate Cox proportional hazard regression methods demonstrated that prealbumin (P=0.002), CA19-9 (P<0.001), the number of tumors (P=0.006), vascular invasion (P=0.042) and differentiation of tumors (P=0.004) were the independent risk factors for OS, and the nomogram constructed by the above factors can predict the OS of ICC patients well and accurately, with the C-index of 0.730. There was a certain correlation between the prealbumin and T, N and M stages of the tumor.

Conclusion

A nomogram containing the prealbumin can accurately predict the prognosis of ICC patients after radical hepatectomy.

Key words: Bile duct neoplasms, Hepatectomy, Prognosis, Nomogram

Zhiping Wu, Yifan Zhang, Xinlang Deng, Wei Chen, Qian Wang. Nomogram model for the prognosis of intrahepatic cholangiocarcinoma after radical resection[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(02): 141-146.

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References 23

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项目		数值	项目		数值
性别［例(%)］		?	前白蛋白(g/L)^a		182(15~395)
?	男	137(52.1)	AST(U/L)^a		26(5~421)
?	女	126(47.9)	ALT(U/L)^a		29(11~415)
年龄(岁) ^a		57(21~79)	γ-GGT (U/L)^a		90(14~2 026)
乙型肝炎病毒感染［例(%)］		?	乳酸脱氢酶(U/L) ^a		199(119~811)
?	有	74(28.1)	肿瘤大小(cm) ^a		5(1~8)
?	无	189(71.9)	肿瘤个数［例(%)］		?
结石病史［例(%)］		?	?	1	188(71.5)
?	有	62(23.6)	?	>1	75(28.5)
?	无	201(76.4)	血管侵犯［例(%)］		?
AFP(μg/L)^a		3.36(1.03~10 714.32)	?	有	55(20.9)
CEA(μg/L)^a		3.14(0.50~3 203.5)	?	无	208(79.1)
CA19-9(U/ml)^a		110.51(0.4~12 000)	分化程度［例(%)］		?
CA125(U/ml)^a		22.4(2.6~10 000)	?	G1+G2	172(65.4)
总胆红素(μmol/L)^a		11.9(2.2~412.7)	?	G3+G4	91(34.6)
白细胞(×10⁹/L)^a		7.12(2.61~16.45)	淋巴结转移［例(%)］		?
中性粒细胞(×10⁹/L)^a		4.43(0.64~11.59)	?	有	85(32.3)
淋巴细胞(×10⁹/L)^a		1.7(0.10~4.41)	?	无	178(67.7)
血小板(×10⁹/L)^a		241(4.83~590)	?	?	?

项目		数值	项目		数值
性别［例(%)］		?	前白蛋白(g/L)^a		182(15~395)
?	男	137(52.1)	AST(U/L)^a		26(5~421)
?	女	126(47.9)	ALT(U/L)^a		29(11~415)
年龄(岁) ^a		57(21~79)	γ-GGT (U/L)^a		90(14~2 026)
乙型肝炎病毒感染［例(%)］		?	乳酸脱氢酶(U/L) ^a		199(119~811)
?	有	74(28.1)	肿瘤大小(cm) ^a		5(1~8)
?	无	189(71.9)	肿瘤个数［例(%)］		?
结石病史［例(%)］		?	?	1	188(71.5)
?	有	62(23.6)	?	>1	75(28.5)
?	无	201(76.4)	血管侵犯［例(%)］		?
AFP(μg/L)^a		3.36(1.03~10 714.32)	?	有	55(20.9)
CEA(μg/L)^a		3.14(0.50~3 203.5)	?	无	208(79.1)
CA19-9(U/ml)^a		110.51(0.4~12 000)	分化程度［例(%)］		?
CA125(U/ml)^a		22.4(2.6~10 000)	?	G1+G2	172(65.4)
总胆红素(μmol/L)^a		11.9(2.2~412.7)	?	G3+G4	91(34.6)
白细胞(×10⁹/L)^a		7.12(2.61~16.45)	淋巴结转移［例(%)］		?
中性粒细胞(×10⁹/L)^a		4.43(0.64~11.59)	?	有	85(32.3)
淋巴细胞(×10⁹/L)^a		1.7(0.10~4.41)	?	无	178(67.7)
血小板(×10⁹/L)^a		241(4.83~590)	?	?	?

变量	P值	HR	95% CI	变量	P值	HR	95% CI
年龄	0.998	1.000	0.985~1.015	总胆红素	0.981	1.000	0.998~1.002
性别(男vs女)	0.326	1.167	0.857~1.588	乳酸脱氢酶	0.012^a	1.002	1.000~1.004
乙型肝炎病毒感染(有vs无)	0.968	1.007	0.717~1.414	AFP	0.800	1.000	1.000
结石(有vs无)	0.173	1.277	0.898~1.815	CEA	0.230	1.000	1.000
白细胞	0.087	1.055	0.992~1.122	CA125	0.008^a	1.000	1.000
中性粒细胞	0.084	1.064	0.992~1.141	CA19-9	<0.001^a	1.000	1.000
淋巴细胞	0.446	0.920	0.743~1.140	肿瘤大小	0.061	1.052	0.998~1.110
血小板	0.120	1.001	1.000~1.003	肿瘤个数(>1 vs 1)	<0.001^a	1.900	1.371~2.633
AST	0.533	1.001	0.999~1.003	血管侵犯(有vs无)	<0.001^a	2.569	1.783~3.702
ALT	0.393	1.001	0.999~1.004	分化程度(G3+G4 vs G1+G2)	0.003^a	1.638	1.187~2.261
γ-GGT	0.301	1.000	1.000~1.001	淋巴结转移(有vs无)	0.007^a	1.553	1.130~2.133
前白蛋白	<0.001^a	0.995	0.993~0.997	?	?	?	?

变量	P值	HR	95% CI	变量	P值	HR	95% CI
年龄	0.998	1.000	0.985~1.015	总胆红素	0.981	1.000	0.998~1.002
性别(男vs女)	0.326	1.167	0.857~1.588	乳酸脱氢酶	0.012^a	1.002	1.000~1.004
乙型肝炎病毒感染(有vs无)	0.968	1.007	0.717~1.414	AFP	0.800	1.000	1.000
结石(有vs无)	0.173	1.277	0.898~1.815	CEA	0.230	1.000	1.000
白细胞	0.087	1.055	0.992~1.122	CA125	0.008^a	1.000	1.000
中性粒细胞	0.084	1.064	0.992~1.141	CA19-9	<0.001^a	1.000	1.000
淋巴细胞	0.446	0.920	0.743~1.140	肿瘤大小	0.061	1.052	0.998~1.110
血小板	0.120	1.001	1.000~1.003	肿瘤个数(>1 vs 1)	<0.001^a	1.900	1.371~2.633
AST	0.533	1.001	0.999~1.003	血管侵犯(有vs无)	<0.001^a	2.569	1.783~3.702
ALT	0.393	1.001	0.999~1.004	分化程度(G3+G4 vs G1+G2)	0.003^a	1.638	1.187~2.261
γ-GGT	0.301	1.000	1.000~1.001	淋巴结转移(有vs无)	0.007^a	1.553	1.130~2.133
前白蛋白	<0.001^a	0.995	0.993~0.997	?	?	?	?

变量	Coef.	Std.Err	P值	HR	95% CI
乳酸脱氢酶	<0.001	0.001	0.655	1.000	0.998~1.003
前白蛋白	-0.004	0.001	0.002^a	0.996	0.994~0.999
CA125	<0.001	<0.001	0.131	1.000	1.000
CA19-9	<0.001	<0.001	<0.001^a	1.000	1.000
肿瘤个数(>1 vs 1)	0.475	0.173	0.006^a	1.608	1.146~2.257
血管侵犯(有vs无)	0.424	0.208	0.042^a	1.529	1.016~2.300
分化程度(G3+G4 vs G1+G2)	0.488	0.171	0.004^a	1.629	1.165~2.278
淋巴结转移(有vs无)	0.165	0.169	0.328	1.180	0.847~1.644

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