Development and Validation of a Prognostic Model to Predict Recurrence-Free Survival After Curative Resection for Perihilar Cholangiocarcinoma: A Multicenter Study

Liu, Zhipeng; Chen, Wei-Yue; Wang, Zi-Ran; Liu, Xing-Chao; Fan, Haining; Xu, Lei; Pan, Yu; Zhong, Shi-Yun; Xie, Dan; Bai, Jie; Jiang, Yan; Zhang, Yanqi; Dai, Hai-Su; Chen, Zhiyu

doi:10.3389/fonc.2022.849053

Cited by 6 publications

(6 citation statements)

References 52 publications

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“…Recently, nomograms as predictive tools have been used, based on some specific variables to predict the risk of achieving a specific outcome for individuals with a certain disease 25 , 40 . In our study, an online nomogram was developed and validated in predicting the probability of achieving TOLS in GBC patients treated with curative-intent resection.…”

Section: Discussionmentioning

confidence: 99%

Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study

Liu

Guo

Yin³

et al. 2023

International Journal of Surgery

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Background: Cholecystectomy, hepatectomy, and lymphadenectomy are recommended as the curative treatment for resectable gallbladder cancer (GBC). Textbook outcomes in liver surgery (TOLS) is a novel composite measure that has been defined by expert consensus to represent the optimal postoperative course after hepatectomy. This study aimed to determine the incidence of TOLS and the independent predictors associated with TOLS after curative-intent resection in GBC patients. Methods: All consecutive GBC patients who underwent curative-intent resection between 2014 and 2020 were enrolled from a multicenter database from 11 hospitals as the training and the internal testing cohorts, and Southwest Hospital as the external testing cohort. TOLS was defined as no intraoperative grade greater than or equal to 2 incidents, no grade B/C postoperative bile leaks, no postoperative grade B/C liver failure, no 90-day postoperative major morbidity, no 90-day readmission, no 90-day mortality after hospital discharge, and R0 resection. Independent predictors of TOLS were identified using logistic regression and were used to construct the nomogram. The predictive performance was assessed using the area under the curve and calibration curves. Results: TOLS was achieved in 168 patients (54.4%) and 74 patients (57.8%) from the training and internal testing cohorts, and the external testing cohort, respectively. On multivariate analyses, age less than or equal to 70 years, absence of preoperative jaundice (total bilirubin≤3 mg/dl), T1 stage, N0 stage, wedge hepatectomy, and no neoadjuvant therapy were independently associated with TOLS. The nomogram that incorporated these predictors demonstrated excellent calibration and good performance in both the training and external testing cohorts (area under the curve: 0.741 and 0.726). Conclusions: TOLS was only achieved in approximately half of GBC patients treated with curative-intent resection, and the constructed nomogram predicted TOLS accurately.

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Section: Discussionmentioning

confidence: 99%

Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study

Liu

Guo

Yin³

et al. 2023

International Journal of Surgery

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“…Patients were divided into two groups according to the upper or lower limits of normal of each preoperative laboratory variable. Specifically, the following thresholds were employed: ALT and AST: 40 U/L, INR: 1.15, ALB: 35 g/L, HGB: 120 g/L, and CA 19-9: 37 U/L ( 13 , 14 , 17 ). All postoperative histopathological variables were confirmed by postoperative histopathological examination of tumor or nontumor tissues.…”

Section: Methodsmentioning

confidence: 99%

“…Curative resection was defined as resection resulting in microscopically clear margins. Curative resection included bile duct resection, biliary reconstruction, hepatectomy, lymph node dissection, and vascular reconstruction for vascular invasion as previously reported (13)(14)(15). Curative resection was performed by experienced surgeons in hepatobiliary surgery in the 3 institutions.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Extent of hepatectomy was divided into major hepatectomy (three or more resected Couinaud liver segments) and minor hepatectomy (two or less resected Couinaud liver segments). In previous studies, pCCA patients with a tumor size > 3 cm showed poor long-term survival (13,14). As a consequence, 3 cm was used to divide patients into 2 groups.…”

Section: Data Collectionmentioning

confidence: 99%

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Impact of perioperative blood transfusion on long-term survival in patients with different stages of perihilar cholangiocarcinoma treated with curative resection: A multicentre propensity score matching study

et al. 2022

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Background & aimThe association of perioperative blood transfusion (PBT) with long-term survival in perihilar cholangiocarcinoma (pCCA) patients after surgical resection with curative intent is controversial and may differ among different stages of the disease. This study aimed to investigate the impact of PBT on long-term survival of patients with different stages of pCCA.MethodsConsecutive pCCA patients from three hospitals treated with curative resection from 2012 to 2019 were enrolled and divided into the PBT and non-PBT groups. Propensity score matching (PSM) was used to balance differences in baseline characteristics between the PBT and non-PBT groups. Kaplan–Meier curves and log-rank test were used to compare overall survival (OS) and recurrence-free survival (RFS) between patients with all tumor stages, early stage (8th AJCC stage I), and non-early stage (8th AJCC stage II-IV) pCCA in the PBT and non-PBT groups. Cox regression analysis was used to determine the impact of PBT on OS and RFS of these patients.Results302 pCCA patients treated with curative resection were enrolled into this study. Before PSM, 68 patients (22 patients in the PBT group) were in the early stage and 234 patients (108 patients in the PBT group) were in the non-early stage. Patients with early stage pCCA in the PBT group had significantly lower OS and RFS rates than those in the non-PBT group. However, there were with no significant differences between the 2 groups with all tumor stages and non-early stage pCCA. After PSM, there were 18 matched pairs of patients with early stage and 72 matched pairs of patients with non-early stage. Similar results were obtained in the pre- and post-PSM cohorts: patients with early stage pCCA in the PBT group showed significantly lower OS and RFS rates than those in the non-PBT group, but there were no significant differences between the 2 groups for patients with all tumor stages and non-early stage pCCA. Cox regression analysis demonstrated that PBT was independently associated with worse OS and RFS for patients with early stage pCCA.ConclusionsPBT had a negative impact on long-term survival in patients with early stage pCCA after curative resection, but not in patients with non-early stage pCCA.

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“…For laboratory parameters, patients were divided into normal and abnormal groups using the upper or lower limit of the normal values used in clinical practice, such as 35 g/L for albumin, 40 U/L for AST, 40 U/L for ALT, 1 mg/dL TB, and 1.15 for INR, as reported in a previous study (25)(26)(27)(28). Cirrhosis was confirmed by histopathological examination.…”

Section: Clinicopathological Variablesmentioning

confidence: 99%

Assessment of the prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in perihilar cholangiocarcinoma patients following curative resection: A multicenter study of 333 patients

Liu

Pan

et al. 2023

Front. Oncol.

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Background & AimsTumor-associated chronic inflammation has been determined to play a crucial role in tumor progression, angiogenesis and immunosuppression. The objective of this study was to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in perihilar cholangiocarcinoma (pCCA) patients following curative resection.MethodsConsecutive pCCA patients following curative resection at 3 Chinese hospitals between 2014 and 2018 were included. The NLR was defined as the ratio of neutrophil count to lymphocyte count. PLR was defined as the ratio of platelet count to lymphocyte count. The optimal cutoff values of preoperative NLR and PLR were determined according to receiver operating characteristic (ROC) curves for the prediction of 1-year overall survival (OS), and all patients were divided into high- and low-risk groups. Kaplan-Meier curves and Cox regression models were used to investigate the relationship between values of NLR and PLR and values of OS and recurrence-free survival (RFS) in pCCA patients. The usefulness of NLR and PLR in predicting OS and RFS was evaluated by time-dependent ROC curves.ResultsA total of 333 patients were included. According to the ROC curve for the prediction of 1-year OS, the optimal cutoff values of preoperative NLR and PLR were 1.68 and 113.1, respectively, and all patients were divided into high- and low-risk groups. The 5-year survival rates in the low-NLR (<1.68) and low-PLR groups (<113.1) were 30.1% and 29.4%, respectively, which were significantly higher than the rates of 14.9% and 3.3% in the high-NLR group (≥1.68) and high-PLR group (≥113.1), respectively. In multivariate analysis, high NLR and high PLR were independently associated with poor OS and RFS for pCCA patients. The time-dependent ROC curve revealed that both NLR and PLR were ideally useful in predicting OS and RFS for pCCA patients.ConclusionsThis study found that both NLR and PLR could be used to effectively predict long-term survival in patients with pCCA who underwent curative resection.

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Development and Validation of a Prognostic Model to Predict Recurrence-Free Survival After Curative Resection for Perihilar Cholangiocarcinoma: A Multicenter Study

Cited by 6 publications

References 52 publications

Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study

Textbook outcomes in liver surgery for gallbladder cancer patients treated with curative-intent resection: a multicenter observational study

Impact of perioperative blood transfusion on long-term survival in patients with different stages of perihilar cholangiocarcinoma treated with curative resection: A multicentre propensity score matching study

Assessment of the prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in perihilar cholangiocarcinoma patients following curative resection: A multicenter study of 333 patients

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