Establishment and validation of a prognostic nomogram for extrahepatic cholangiocarcinoma

Abstract

Simple summaryAccurately estimate the prognosis of patients with ECCA is important. However, the TNM system has some limitations, such as low accuracy, exclusion of other factors (e.g., age and sex), and poor performance in predicting individual survival risk. In contrast, a nomogram-based clinical model related to a comprehensive analysis of all risk factors is intuitive and straightforward, facilitating the probabilistic analysis of tumor-related risk factors. Simultaneously, a nomogram can also effectively drive personalized medicine and facilitate clinicians for prognosis prediction. Therefore, we construct a novel practical nomogram and risk stratification system to predict CSS in patients with ECCA.BackgroundAccurately estimate the prognosis of patients with extrahepatic cholangiocarcinoma (ECCA) was important, but the existing staging system has limitations. The present study aimed to construct a novel practical nomogram and risk stratification system to predict cancer-specific survival (CSS) in ECCA patients.Methods3415 patients diagnosed with ECCA between 2010 and 2015 were selected from the SEER database and randomized into a training cohort and a validation cohort at 7:3. The nomogram was identified and calibrated using the C-index, receiver operating characteristic curve (ROC), and calibration plots. Decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and the risk stratification were used to compare the nomogram with the AJCC staging system.ResultsNine variables were selected to establish the nomogram. The C-index (training cohort:0.785; validation cohort:0.776) and time-dependent AUC (>0.7) showed satisfactory discrimination. The calibration plots also revealed that the nomogram was consistent with the actual observations. The NRI (training cohort: 1-, 2-, and 3-year CSS:0.27, 0.27,0.52; validation cohort:1-,2-,3-year CSS:0.48,0.13,0.34), IDI (training cohort: 1-, 2-, 3-year CSS:0.22,0.18,0.16; validation cohort: 1-,2-,3-year CSS:0.18,0.16,0.17), and DCA indicated that the established nomogram significantly outperformed the AJCC staging system (P<0.05) and had better recognition compared to the AJCC staging system.ConclusionsWe developed a practical prognostic nomogram to help clinicians assess the prognosis of patients with ECCA.

Prognostic model for oversurvival and tumor-specific survival prediction in patients with advanced extrahepatic cholangiocarcinoma: a population-based analysis

“…By the time of follow-up, we found a 3-year cumulative mortality rate of 78.0% and 15.0% for CSS and non-cancer-specific mortality, respectively, indicating a large competitive relationship between CSS and non-cancer-specific mortality. Generally, a higher age is the main reason for a competitive relationship [22] . However, in the present study, increasing age was not significantly associated with OS in patients with advanced ECCA and was more irrelevant in CSS.…”

“…The nomogram facilitates the development of individualized treatment regimens by physicians, offers more precise prognostic predictions, and has been applied to the evaluation of a variety of malignancies such as colorectal cancer,osteosarcoma and lung cancer [32[34] . Prognostic nomogram establishment was carried out in ECCA patients by Fang et al, showed that nomograms are more predictive for patient survival than AJCC staging [22] . As in our study, in comparison to the 7th AJCC stage, the produced nomograms displayed higher time-dependent C-indexes and AUC values, demonstrating their modified discriminative ability to predict OS and CSS.…”