Influencing factors of prognosis of intrahepatic cholangiocarcinoma after anatomical hepatectomy and construction of nomogram model
Objective To analyze the influencing factors of poor prognosis of intrahepatic cholangiocarcinoma(ICC)after anatomical hepatectomy,to construct the nomogram model and to verify the predictive value of the nomogram model.Methods From January 2016 to August 2018,147 patients with ICC were performed anatomical hepatectomy in the Second People's Hospital of Nanyang,and were divided into poor prognosis group(n=67)and good prognosis group(n=80)according to the 5-year survival.The preoperative clinical data as Child-Pugh classification,TNM stage,tumor number,tumor location,lymph node metastasis,vascular invasion,and serum carbohydrate antigen 19-9(CA19-9)level were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of poor prognosis of ICC patients after anatomical hepatectomy.A nomogram model was constructed based on the influencing factors to predict the poor prognosis of ICC patients after anatomical hepatectomy.ROC curve and calibration curve were plotted to evaluate the discrimination and calibration of the nomogram model.Results The rates of multiple tumors,lymph node metastasis,vascular invasion,and serum CA19-9＞89 u/mL were higher in poor prognosis group(29.9％,37.3％,25.4％,71.6％)than those in good prognosis group(11.2％,16.3％,10.0％,47.5％)(P＜0.05),the maximum diameter of the tumor was longer in poor prognosis group[(6.21±1.48)cm]than that in good prognosis group[(3.45±1.33)cm](t=11.902,P＜0.001),and there were no significant differences in the Child-Pugh classification,TNM stage,tumor location,pathological classification,serum alpha-fetoprotein,and the rates of hypertension,diabetes,smoking habits,alcohol consumption,peritoneal fluid,and positive hepatitis B surface antigen between two groups(P＞0.05).Multiple tumors(OR=32.122,95％CI:3.772-273.581,P=0.002),maximum diameter of the tumor(OR=5.762,95％CI:3.055-10.870,P＜0.001),lymph node metastasis(OR=10.591,95％CI:1.978-56.704,P=0.006),vascular invasion(OR=10.757,95％CI:1.591-72.747,P=0.015),and serum CA19-9＞89 u/mL(OR=7.165,95％CI:1.640-31.314,P=0.009)were the influencing factors of poor prognosis of ICC patients after anatomical hepatectomy.The AUC of the nomogram model for predicting poor prognosis after anatomical hepatectomy in ICC patients was 0.956(95％CI:0.924-0.988,P＜0.001),with a sensitivity of 88.1％and a specificity of 80.6％.The calibration curve of the nomogram model fitted well with the ideal curve.Conclusion Multiple tumors,maximum diameter of tumor,lymph node metastasis,vascular invasion,and serum CA19-9＞89 u/mL are the influencing factors of poor prognosis of ICC patients after anatomical hepatectomy,and the nomogram model constructed based on the above indicators has a high predictive value.
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