Independent Risk Factors of Early Recurrence After Curative Resection for Perihilar Cholangiocarcinoma: Adjuvant Chemotherapy May Be Beneficial in Early Recurrence Subgroup

Zhao, Jian; Zhang, Wei; Zhang, Jun; Chen, Yuntian; Ma, Wen‐Jie; Liu, Si-Yun; Li, Fuyu; Song, Bin

doi:10.2147/cmar.s289094

Cited by 9 publications

(15 citation statements)

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“…A recent study suggested that poor pathological differentiation, perineural invasion, and high levels of preoperative CA19-9 were independent risk factors of ER. 5 All these studies included postoperative variables. Our research exploring preoperative factors found that high level of CEA and invasion of hepatic artery in images were associated with a higher likelihood of ER, whereas high level of blood glucose level and white blood cell count were associated with lower odds of ER independently.…”

Section: Discussionmentioning

confidence: 99%

“…The ER of pCCA was defined as the occurrence of recurrence within 12 months after surgery based on previous studies. 5 So, individuals had recurrence within 12 months after surgery were enrolled to group ER, whereas those experienced tumor recurrence later or did not suffer from recurrence were classified into group non-ER. OS was defined as the interval between the date of operation and the date of last follow-up or death.…”

Section: Patient Cohort and Data Collectionmentioning

confidence: 99%

“…6 Recent studies have also shown that patients in the early relapse subgroup can benefit from adjuvant chemotherapy. 5,7 Hence, in order to improve patient's prognosis, it might be necessary to identify patients with a high risk of postoperative ER before surgery.…”

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confidence: 99%

“…Patients who experience early recurrence (ER) have a worse prognosis. A recent study reported that the median overall survival (OS) of the ER patients was only 15 months after surgery 5 . From the perspective of treatment results, it seems that ER patients can be treated in the same way as patients with progressive disease 6 .…”

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confidence: 99%

“…From the perspective of treatment results, it seems that ER patients can be treated in the same way as patients with progressive disease 6 . Recent studies have also shown that patients in the early relapse subgroup can benefit from adjuvant chemotherapy 5,7 . Hence, in order to improve patient's prognosis, it might be necessary to identify patients with a high risk of postoperative ER before surgery.…”

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Development and Validation of Noninvasive MRI‐Based Signature for Preoperative Prediction of Early Recurrence in Perihilar Cholangiocarcinoma

Zhao

Zhang²,

Zhu³

et al. 2021

Magnetic Resonance Imaging

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Background Cholangiocarcinoma is a type of hepatobiliary tumor. For perihilar cholangiocarcinoma (pCCA), patients who experience early recurrence (ER) have a poor prognosis. Preoperative accurate prediction of postoperative ER can avoid unnecessary operation; however, prediction is challenging. Purpose To develop a novel signature based on clinical and/or MRI radiomics features of pCCA to preoperatively predict ER. Study Type Retrospective. Population One hundred eighty‐four patients (median age, 61.0 years; interquartile range: 53.0–66.8 years) including 115 men and 69 women. Field Strength/Sequence A 1.5 T; volumetric interpolated breath‐hold examination (VIBE) sequence. Assessment The models were developed from the training set (128 patients) and validated in a separate testing set (56 patients). The contrast‐enhanced arterial and portal vein phase MR images of hepatobiliary system were used for extracting radiomics features. The correlation analysis, least absolute shrinkage and selection operator (LASSO) logistic regression (LR), backward stepwise LR were mainly used for radiomics feature selection and modeling (Modelradiomic). The univariate and multivariate backward stepwise LR were used for preoperative clinical predictors selection and modeling (Modelclinic). The radiomics and preoperative clinical predictors were combined by multivariate LR method to construct clinic‐radiomics nomogram (Modelcombine). Statistical Tests Chi‐squared (χ2) test or Fisher's exact test, Mann–Whitney U‐test or t‐test, Delong test. Two tailed P < 0.05 was considered statistically significant. Results Based on the comparison of area under the curves (AUC) using Delong test, Modelclinic and Modelcombine had significantly better performance than Modelradiomic and tumor‐node‐metastasis (TNM) system in training set. In the testing set, both Modelclinic and Modelcombine had significantly better performance than TNM system, whereas only Modelcombine was significantly superior to Modelradiomic. However, the AUC values were not significantly different between Modelclinic and Modelcombine (P = 0.156 for training set and P = 0.439 for testing set). Data Conclusion A noninvasive model combining the MRI‐based radiomics signature and clinical variables is potential to preoperatively predict ER for pCCA. Level of Evidence 3 Technical Efficacy Stage 4

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