Diagnostic and prognostic nomograms for Distal Metastasis in Intrahepatic cholangiocarcinoma: A SEER-Based Study

Abstract

Background and objectives: Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor originating from the bile duct epithelium above the confluence of the left and right hepatic ducts, in which distant metastases (DM) continue to result in a worse prognosis. This study systematically extracted the clinical-pathological data for ICC patients from the Surveillance, Epidemiology, and End Results (SEER) database, aiming to detect prognostic and predictive factors for DM in ICC patients and to generate two nomograms to assess the DM risk and prognosis in patients with ICC.Methods: From 2010 to 2015, the SEER database was used to extract clinical and treatment information of individuals with a pathological diagnosis of ICC. Multivariate and univariate logistic analyses were assessed to detect the risk factors related to the occurrence of DM in patients with ICC. Multivariate and univariate analyses of Cox regression were assessed to detect prognostic risk factors for DM in ICC patients, and two nomograms were formed.Results: This study included 2089 participants with ICC. Stage T, stage N, and gender were all risk factors that are related to the development of DM in ICC patients. Age, gender, stage T, surgery, and chemotherapy were found to be related prognostic factors in individuals with ICC who had DM. Among the training group, the area under the curve (AUC) for the diagnostic nomogram was 0.705, and the AUC was 0.670 in the testing group. At 6, 9, and 12 months, the AUCs for the prognostic nomogram were 0.778, 0.759, and 0.721 in the training group, and 0.792, 0.755, and 0.730 in the testing group, respectively. The calibration curves and decision curve analysis (DCA) showed that the two nomograms have good calibrate performance and clinic clinical application values. Finally, the Kaplan-Meier (K-M) curves showed a significant difference in prognostic survival between patients in the high-risk and low-risk groups.Conclusion: Based on the SEER database we successfully constructed two nomograms for assessing the risk of DM in ICC patients and the prognosis of ICC patients with DM, which will assist clinicians in decision-making and personalized clinical care.