Nomogram Predicts Intrahepatic Cholangiocarcinoma Patient Survival

Key risk factors for the survival of patients with intrahepatic cholangiocarcinoma have been identified

medwireNews: An international team of researchers has devised a nomogram to predict the survival of patients after surgery for intrahepatic cholangiocarcinoma (ICC).

Patients in the top quartile for survival, based on points awarded for six prognostic factors, had a median survival of 80.2 months compared with just 14.8 months for those in the lowest quartile, report Timothy Pawlik, from Johns Hopkins University School of Medicine in Baltimore, Maryland, USA, and co-workers.

Patients in the first, second, third and fourth quartiles had 5-year survivals of 64.6%, 50.0%, 31.0% and 15.4%, respectively, with the nomogram found to have a “good” predictive accuracy of 0.692 using the Harrell C index.

This suggests that the nomogram has “clinical utility to improve individualized predictions of survival for patients undergoing resection of ICC,” the team writes in JAMA Surgery.

The researchers identified prognostic factors using data for 514 ICC patients from Europe, the USA and Asia who underwent extended hepatectomy, hemihepatectomy or minor liver resection between 1990 and 2011.

Overall, 10.9% of patients had macroscopic vascular invasion, 13.2% microscopic invasion and 37.5% had N1 spread. The majority (87.7%) had T1 or T2 disease with 56.0% found to have tumours 5 cm in diameter or larger. In all, 87.9% of patients had clean surgical margins.

Multivariate analysis identified the significant prognostic nomogram variables for overall survival to be extremes of age (hazard ratio [HR]=1.31), multiple tumours (HR=1.58), tumour size (HR=1.50), lymph node metastasis (HR=1.78) and macroscopic vascular invasion (HR=2.10).

Interestingly, age and tumour size were not linear predictors, however, and the nomogram was adjusted to account for this.

Cirrhosis was also associated with prognosis, although the HR did not reach statistical significance. Other factors, such as HIV or hepatitis B virus infection, perineural or biliary invasion, and moderate tumour differentiation did not predict prognosis.

“Future studies should externally validate the proposed nomogram to establish more fully its value in the clinical prognostication of patients with ICC after surgical resection,” conclude the researchers.


Hyder O, Marques H, Puliatno C et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma. An Eastern and Western experience. JAMA Surg; 5 March 2014. doi:10.1001/jamasurg.2013.5168

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