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Mu Y, Luo J, Xiong T, Zhang J, Lan J, Zhang J, Tan Y, Yang S. Development and validation of nomogram model predicting overall survival and cancer specific survival in glioblastoma patients. Discov Oncol 2025; 16:562. [PMID: 40249416 PMCID: PMC12008090 DOI: 10.1007/s12672-025-02331-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 04/08/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND Identifying the incidence and risk factors of Glioblastoma (GBM) and establishing effective predictive models will benefit the management of these patients. METHODS Using GBM data from the Surveillance, Epidemiology, and End Results (SEER) database, we used Joinpoint software to assess trends in GBM incidence across populations of different age groups. Subsequently, we identified important prognostic factors by stepwise regression and multivariate Cox regression analysis, and established a Nomogram mathematical model. COX regression model combined with restricted cubic splines (RCS) model was used to analyze the relationship between tumor size and prognosis of GBM patients. RESULTS The incidence of GBM has been on the rise since 1978, especially in the age group of 65-84 years. 11498 patients with GBM were included in our study. The multivariate Cox analysis revealed that age, tumor size, sex, primary tumor site, laterality, number of primary tumors, surgery, chemotherapy, radiotherapy, systematic therapy, marital status, median household income, first malignant primary indicator were independent prognostic factors of overall survival (OS) for GBMs. For cancer-specific survival (CSS), race is also independent prognostic factors. Additionally, risk of poor prognosis increased significantly with tumor size in patients with tumors smaller than 49 mm. Moreover, our nomogram model showed favorable discriminative ability. CONCLUSION At the population level, the incidence of GBM is on the rise. The relationship between tumor size and patient prognosis is still worthy of further study. Moreover, the proposed nomogram with good performance was constructed and verified to predict the OS and CSS of patients with GBM.
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Affiliation(s)
- Yingming Mu
- Department of General Neurology, Ziyun Miao Buyi Autonomous County People's Hospital, Guiyang, China
| | - Junchi Luo
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Tao Xiong
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Junheng Zhang
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jinhai Lan
- Department of Orthopedics, Ziyun Miao Buyi Autonomous County People's Hospital, Guiyang, China
| | - Jiqin Zhang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ying Tan
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, China.
| | - Sha Yang
- Guizhou University Medical College, Guiyang, 550025, Guizhou, China.
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De Rose AM, Taliente F, Panettieri E, Moschetta G, Belia F, Ardito F, Giuliante F. Evolving surgical techniques for hepatolithiasis: A retrospective analysis of 164 liver resections at a Western center. Surgery 2025; 182:109330. [PMID: 40179530 DOI: 10.1016/j.surg.2025.109330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/10/2025] [Accepted: 02/18/2025] [Indexed: 04/05/2025]
Abstract
OBJECTIVE To assess the outcomes of liver resection for primary intrahepatic lithiasis in a Western population, emphasizing the evolution of surgical techniques, including minimally invasive surgery, and their impact on patient outcomes. METHODS We performed a retrospective analysis of 164 patients who underwent liver resection for primary intrahepatic lithiasis at the Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. Data included demographics, surgical techniques, complications, and long-term outcomes. Minimally invasive surgery was introduced and progressively adopted, and its outcomes were compared with open surgery using propensity score matching. This represents the largest Western dataset on liver resection for primary intrahepatic lithiasis published to date. RESULTS Liver resections were predominantly unilateral (96%) and commonly targeted the left liver (65%). Minimally invasive surgery use increased to 60% in the most recent period, showing reduced morbidity and shorter hospital stays compared with open surgery. Postoperative complications included bile fistula (16%) and septic events (30%). Independent risk factors for bile fistula were previous cholangitis (odds ratio, 4.7; P = .006) and major hepatectomy (odds ratio, 7.8; P = .002). Septic complications were associated with previous cholangitis (odds ratio, 2.3; P = .026), bilateral lithiasis (odds ratio, 4.0; P = .010), and major hepatectomy (odds ratio, 3.5; P = .003), with minimally invasive surgery providing a protective effect (odds ratio, 0.34; P = .028). Long-term follow-up revealed a 20% recurrence rate, linked to incomplete intraoperative stone clearance (hazard ratio, 2.645; P = .019) and biliary fistula (hazard ratio, 2.799; P = .016). Cholangiocarcinoma occurred in 6.6%, underscoring the need for surveillance. CONCLUSION Liver resection is an effective, curative treatment for primary intrahepatic lithiasis in Western populations. Minimally invasive surgery advancements significantly improve short-term outcomes, bridging the East-West gap in primary intrahepatic lithiasis management and highlighting the importance of individualized surgical approaches.
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Affiliation(s)
- Agostino Maria De Rose
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Taliente
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Moschetta
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Belia
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Qi S, Ma Z, Shen L, Wang J, Zhou L, Tian B, Liu C, Chen K, Cheng W. Application of preoperative NLR-based prognostic model in predicting prognosis of intrahepatic cholangiocarcinoma following radical surgery. Front Nutr 2024; 11:1492358. [PMID: 39539368 PMCID: PMC11557473 DOI: 10.3389/fnut.2024.1492358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 10/16/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose To investigate the application value of the neutrophil to lymphocyte count ratio (NLR) in the prognostic analysis of intrahepatic cholangiocarcinoma (ICC) after radical resection, and to offer guidance for the individualized perioperative diagnosis and treatment of ICC. Methods The clinical data of 360 patients diagnosed with ICC following radical surgery were retrospectively analyzed. The cut-off value of NLR was calculated using the minimum p-value method, and then divided into High-NLR (H-NLR) group and Low-NLR (L-NLR) group according to the NLR cut-off value. The prognostic value of NLR in ICC was analyzed. Subsequently, the patients were divided into the hepatolithiasis-related intrahepatic cholangiocarcinoma (HICC) group and the non-hepatolithiasis-related intrahepatic cholangiocarcinoma (NHICC) group based on whether they combined with hepatolithiasis. Multiple regression models were constructed based on NLR and clinicopathological indicators to verify the application value of prognostic models in the survival and recurrence of ICC patients after radical surgery. Results The cut-off value of NLR was 2.36, and the survival analysis disclosed that overall ICC patients with NLR ≥ 2.36 manifested a poor 5-year survival rate and a higher tumor recurrence rate (p < 0.001). In the HICC group, patients with H-NLR presented a poor 5-year survival rate and a higher tumor recurrence rate compared with L-NLR (p < 0.001). The NLR-based survival/recurrence prediction models in the HICC group demonstrated excellent predictive capacity (H-L test: 0.359/0.680, AUC: 0.764/0.791). In the NHICC group, patients with H-NLR exhibited a poor 5-year survival rate compared with L-NLR (p < 0.001), yet there was no significant difference in tumor recurrence between the two groups (p = 0.071). The NLR-based survival prediction model in the NHICC group demonstrated acceptable predictive ability (H-L test: 0.268, AUC: 0.729), while the NLR-based recurrence prediction model did not show an effective predictive ability (H-L test: 0.01, AUC: 0.649). Conclusion NLR is an independent risk factor influencing postoperative survival and recurrence in ICC patients, particularly in HICC patients. Preoperative NLR ≥ 2.36 suggests that patients might have a poor prognosis. The survival and recurrence prediction model constructed based on NLR and other clinical indicators demonstrates good prediction accuracy and can effectively predict the risk of postoperative adverse prognosis in patients with HICC. This study offers a novel idea for the clinical treatment of HICC patients.
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Affiliation(s)
| | | | | | | | | | | | - Changjun Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Kang Chen
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wei Cheng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Luo B, Wu SK, Zhang K, Wang PH, Chen WW, Fu N, Yang ZM, Hao JC. Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones. World J Gastrointest Surg 2024; 16:3133-3141. [PMID: 39575299 PMCID: PMC11577404 DOI: 10.4240/wjgs.v16.i10.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/23/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND For intrahepatic duct (IHD) stones, laparoscopic liver resection (LLR) is currently a reliable treatment. However, the current LLR difficulty scoring system (DSS) is only available for patients with hepatocellular carcinoma. AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability. METHODS We used clinical data from 80 patients who received LLR for IHD stones. Forty-six of these patients were used in multiple linear regression to construct a scoring system. Another 34 patients from different centers were used as external validation. The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients. RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort: Location of stones, number of stones ≥ 3, stones located in the bile ducts of several grades, previous biliary surgery less than twice, distal bile duct atrophy. Subsequently, the data set was validated using a DSS developed from the variables. The following variables were identified as statistically significant in external validation: Operative time, blood loss, intraoperative transfusion, postoperative alanine aminotransferase, and Clavien-Dindo grading ≥ 3. These variables demonstrated statistically significant differences in patients with three or more grades. CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty, and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.
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Affiliation(s)
- Bo Luo
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Si-Kai Wu
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Ke Zhang
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Pei-Hong Wang
- Department of General Surgery, The Western Theater Command General Hospital, Chengdu 610500, Sichuan Province, China
| | - Wei-Wei Chen
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Ning Fu
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Zhi-Ming Yang
- Department of Hepatobiliary and Vascular Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
| | - Jing-Cheng Hao
- Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
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Bai S, Shi X, Dai Y, Wang H, Xia Y, Liu J, Wang K. The preoperative scoring system combining neutrophil/lymphocyte ratio and CA19-9 predicts the long-term prognosis of intrahepatic cholangiocarcinoma patients undergoing curative liver resection. BMC Cancer 2024; 24:1106. [PMID: 39237882 PMCID: PMC11378368 DOI: 10.1186/s12885-024-12819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/16/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND This study aims to investigate preoperative prognostic factors available for intrahepatic cholangiocarcinoma (ICC) patients and propose a new preoperative prognostic scoring system for ICC that combines CA19-9 and neutrophil/lymphocyte ratio (NLR). METHODS In this retrospective analysis, 1728 patients diagnosed with ICC and undergoing curative liver resections were studied. This study employed univariate and multivariate Cox regression to find factors affecting recurrence and overall survival (OS), and furthermore assessed how preoperative models influenced tumor traits and postoperative recurrence. RESULTS The results of the multivariate Cox regression analysis indicated that two preoperative variables, NLR and Ca19-9, were independent risk factors affecting postoperative recurrence and OS in ICC patients. Based on this data, assigning a score of 0 (NLR ≤ 2.4 and Ca19-9 ≤ 37U/ml) or 1 (NLR > 2.4 and Ca19-9 > 37U/ml) to these two factors, a preoperative prognostic score was derived. According to the scoring model, patients were divided into three groups: 0 points (low-risk group), 1 point (intermediate-risk group), and 2 points (high-risk group). The 5-year recurrence and OS rates for the three groups were 56.6%, 68.2%, 77.8%, and 56.8%, 40.6%, 27.6%, respectively, with all P values < 0.001. Furthermore, high-risk group patients were more prone to early recurrence (early recurrence rates for high-, intermediate-, and low-risk groups were 56.8%, 51.5%, and 37.1%, respectively, P < 0.001) and extrahepatic metastasis (extrahepatic metastasis rates for high-, intermediate-, and low-risk groups were 31.7%, 26.4%, and 15.4%, respectively, P < 0.001). In terms of tumor characteristics, high-risk group patients had larger tumor diameters and were more likely to experience microvascular invasion, lymph node metastasis, and perineural invasion. CONCLUSIONS The predictive capacity of postoperative recurrence and OS rates in ICC patients is effectively captured by the preoperative scoring system incorporating NLR and CA19-9 levels.
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Affiliation(s)
- Shilei Bai
- Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), No. 225, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Xiaodong Shi
- Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), No. 225, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Yizhe Dai
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
| | - Huifeng Wang
- Department of Hepatic Surgery, the Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Yong Xia
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
| | - Jian Liu
- Department of Biliary Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China.
| | - Kui Wang
- Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), No. 225, Changhai Road, Yangpu District, Shanghai, 200438, People's Republic of China.
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Yuan C, Zou S, Wang K, Hu Z. Establishment and external validation of prognosis prediction nomogram for patients with distant metastatic intrahepatic cholangiocarcinoma: based on a large population. BMC Cancer 2024; 24:227. [PMID: 38365630 PMCID: PMC10874087 DOI: 10.1186/s12885-024-11976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Most patients with intrahepatic cholangiocarcinoma (ICC) have developed distant metastasis at the time of diagnosis, while there is rear related nomogram to predict the prognosis. METHODS Clinical data of patients pathologically diagnosed of ICC with distant metastasis were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2005 to 2019. Finally, patients diagnosed as ICC in the Second Affiliated Hospital of Nanchang University from 2014 to 2019 were collected for external verification. All data were divided into training cohort and validation cohort in a ratio of 7:3. The nomogram was established based on independent prognostic factors using Cox univariate and multivariate analyses. The area under the receiver operating characteristic (ROC) curves (AUC), the calibration curve and the decision curve analysis (DCA) were used to determine the prediction accuracy of the nomogram. RESULTS This study finally included 572 ICC with distant metastasis patients, another 32 patients collected by the author's hospital were used as external verification. Results showed that age, surgery, radiotherapy and chemotherapy were independent prognostic factors, and nomogram was established. The AUC of predicting 3, 6, 9-month overall survival were 0.866, 0.841 and 0.786. The ROC curves and calibration curves showed that the nomogram had good predictive accuracy, and DCA showed that the nomogram had good clinical applicability. CONCLUSIONS The nomogram has good accuracy in predicting prognosis of DM-ICC patients, which would be of good significance to improve the prognosis of these patients.
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Affiliation(s)
- Chen Yuan
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
- East China Institute of Digital Medical Engineering, Shangrao, China
| | - Shubing Zou
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Kai Wang
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Zhigang Hu
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China.
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China.
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China.
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Huang G, Zhang H, Yang Z, Li Q, Yuan H, Chen P, Xie C, Meng B, Zhang X, Chen K, Yu H. Predictive value of HTS grade in patients with intrahepatic cholangiocarcinoma undergoing radical resection: a multicenter study from China. World J Surg Oncol 2024; 22:17. [PMID: 38200585 PMCID: PMC10782600 DOI: 10.1186/s12957-023-03281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is a highly malignant tumor with a poor prognosis. This study aimed to investigate whether Hemoglobin, Albumin, Lymphocytes, and Platelets (HALP) score and Tumor Burden Score (TBS) serves as independent influencing factors following radical resection in patients with ICC. Furthermore, we sought to evaluate the predictive capacity of the combined HALP and TBS grade, referred to as HTS grade, and to develop a prognostic prediction model. METHODS Clinical data for ICC patients who underwent radical resection were retrospectively analyzed. Univariate and multivariate Cox regression analyses were first used to find influencing factors of prognosis for ICC. Receiver operating characteristic (ROC) curves were then used to find the optimal cut-off values for HALP score and TBS and to compare the predictive ability of HALP, TBS, and HTS grade using the area under these curves (AUC). Nomogram prediction models were constructed and validated based on the results of the multivariate analysis. RESULTS Among 423 patients, 234 (55.3%) were male and 202 (47.8) were aged ≥ 60 years. The cut-off value of HALP was found to be 37.1 and for TBS to be 6.3. Our univariate results showed that HALP, TBS, and HTS grade were prognostic factors of ICC patients (all P < 0.05), and ROC results showed that HTS had the best predictive value. The Kaplan-Meier curve showed that the prognosis of ICC patients was worse with increasing HTS grade. Additionally, multivariate regression analysis showed that HTS grade, carbohydrate antigen 19-9 (CA19-9), tumor differentiation, and vascular invasion were independent influencing factors for Overall survival (OS) and that HTS grade, CA19-9, CEA, vascular invasion and lymph node invasion were independent influencing factors for recurrence-free survival (RFS) (all P < 0.05). In the first, second, and third years of the training group, the AUCs for OS were 0.867, 0.902, and 0.881, and the AUCs for RFS were 0.849, 0.841, and 0.899, respectively. In the first, second, and third years of the validation group, the AUCs for OS were 0.727, 0.771, and 0.763, and the AUCs for RFS were 0.733, 0.746, and 0.801, respectively. Through the examination of calibration curves and using decision curve analysis (DCA), nomograms based on HTS grade showed excellent predictive performance. CONCLUSIONS Our nomograms based on HTS grade had excellent predictive effects and may thus be able to help clinicians provide individualized clinical decision for ICC patients.
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Affiliation(s)
- Guan Huang
- Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haofeng Zhang
- Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhenwei Yang
- Department of Hepatobiliary Surgery, People's Hospital of Henan University, Zhengzhou, Henan Province, China
| | - Qingshan Li
- Department of Hepatobiliary Surgery, Henan Province People's Hospital, Zhengzhou, Henan Province, China
| | - Hao Yuan
- Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Pengyu Chen
- Department of Hepatobiliary Surgery, People's Hospital of Henan University, Zhengzhou, Henan Province, China
| | - Chenxi Xie
- Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bo Meng
- Department of Hepatobiliary Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xianzhou Zhang
- Department of Hepatobiliary Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Kunlun Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haibo Yu
- Department of Hepatobiliary Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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Pu T, Chen JM, Li ZH, Jiang D, Guo Q, Li AQ, Cai M, Chen ZX, Xie K, Zhao YJ, Wang C, Hou H, Lu Z, Geng XP, Liu FB. Clinical online nomogram for predicting prognosis in recurrent hepatolithiasis after biliary surgery: A multicenter, retrospective study. World J Gastroenterol 2022; 28:715-731. [PMID: 35317276 PMCID: PMC8891727 DOI: 10.3748/wjg.v28.i7.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/20/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Methods for predicting the prognosis of patients undergoing surgery for recurrent hepatolithiasis after biliary surgery are currently lacking.
AIM To establish a nomogram to predict the prognosis of patients with recurrent hepatolithiasis after biliary surgery.
METHODS In this multicenter, retrospective study, data of consecutive patients in four large medical centers who underwent surgery for recurrent hepatolithiasis after biliary surgery were retrospectively analyzed. We constructed a nomogram to predict the prognosis of recurrent hepatolithiasis in a training cohort of 299 patients, following which we independently tested the nomogram in an external validation cohort of 142 patients. Finally, we used the concordance index (C-index), calibra-tion, area under curve, decision curve analysis, clinical impact curves, and visual fit indices to evaluate the accuracy of the nomogram.
RESULTS Multiple previous surgeries [2 surgeries: Odds ratio (95% confidence interval), 1.451 (0.719-2.932); 3 surgeries: 4.573 (2.015-10.378); ≥ 4 surgeries: 5.741 (1.347-24.470)], bilateral hepatolithiasis [1.965 (1.039-3.717)], absence of immediate clearance [2.398 (1.304-4.409)], neutrophil-to-lymphocyte ratio ≥ 2.462 [1.915 (1.099-3.337)], and albumin-to-globulin ratio ≤ 1.5 [1.949 (1.056-3.595)] were found to be independent factors influencing the prognosis. The nomogram constructed on the basis of these variables showed good reliability in the training (C-index: 0.748) and validation (C-index: 0.743) cohorts. Compared with predictions using traditional classification models, those using our nomogram showed better agreement with actual observations in the calibration curve for the probability of endpoints and the receiver operating characteristic curve. Dichloroacetate and clinical impact curves showed a larger net benefit of the nomogram.
CONCLUSION The nomogram developed in this study demonstrated superior performance and discriminative power compared to the three traditional classifications. It is easy to use, highly accurate, and shows excellent calibration.
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Affiliation(s)
- Tian Pu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jiang-Ming Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zi-Han Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Dong Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Qi Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ang-Qing Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Ming Cai
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Zi-Xiang Chen
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Kun Xie
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yi-Jun Zhao
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Cheng Wang
- Department of General Surgery, The First Affiliated Hospital of the University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Xiao-Ping Geng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Fu-Bao Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Hewitt DB, Brown ZJ, Pawlik TM. Surgical management of intrahepatic cholangiocarcinoma. Expert Rev Anticancer Ther 2021; 22:27-38. [PMID: 34730474 DOI: 10.1080/14737140.2022.1999809] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Intrahepatic cholangiocarcinoma (ICC) incidence continues to rise worldwide, and overall survival remains poor. Complete surgical resection remains the only opportunity for cure in patients with ICC yet only one-third of patients present with resectable disease. AREAS COVERED While the low incidence rate of ICC hinders accrual of patients to large, randomized control trials, larger database and long-term institutional studies provide evidence to guide surgical management of ICC. These studies demonstrate feasibility, safety, and efficacy of aggressive surgical management in appropriately selected patients with ICC. Recent advances in the management of ICC, with a focus on surgical considerations, are reviewed. EXPERT OPINION Historically, little progress has been made in the management of ICC with stagnant mortality rates and poor long-term outcomes. However, regionalization of care to centers with experienced multidisciplinary teams, advances in minimally invasive surgical techniques, discovery and development of targeted and immunotherapy agents, and combination locoregional and systemic therapies offer signs of progress in the management of ICC.
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Affiliation(s)
- D Brock Hewitt
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zachary J Brown
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Serifis N, Tsilimigras DI, Cloonan DJ, Pawlik TM. Challenges and Opportunities for Treating Intrahepatic Cholangiocarcinoma. Hepat Med 2021; 13:93-104. [PMID: 34754247 PMCID: PMC8572023 DOI: 10.2147/hmer.s278136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is one of the rarest and most aggressive types of cancer. The symptoms of ICC patients can be vague, leading to late diagnosis and dismal prognosis. In this review, we investigated the treatment options for ICC, as well as ways to overcome challenges in identifying and treating this disease. Imaging remains the gold standard to diagnose ICC. Patients are staged based on the tumor, nodes and metastases (TNM) staging system. Patients eligible for surgical resection should undergo surgery with curative intent with the goal of microscopically disease-free margins (R0 resection) along with lymphadenectomy. Minimal invasive surgery (MIS) and liver transplantation have recently been offered as possible ways to improve disease outcomes. ICC recurrence is relatively common and, thus, most patients will need to be treated with systemic therapy. Several clinical trials have recently investigated the use of neoadjuvant (NT) and adjuvant therapies for ICC. NT may offer an opportunity to downsize larger tumors and provide patients, initially ineligible for surgery, with an opportunity for resection. NT may also treat occult micro-metastatic disease, as well as define tumor biology prior to surgical resection, thereby decreasing the risk for early postoperative recurrence. Adjuvant systemic therapy may improve outcomes of patients with ICC following surgery. Ongoing clinical trials are investigating new targeted therapies that hold the hope of improving long-term outcomes of patients with ICC.
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Affiliation(s)
- Nikolaos Serifis
- Center for Transplantation Sciences, Massachusetts General Hospital, Boston, MA, USA
| | | | - Daniel J Cloonan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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