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Author Notes:

Corresponding Author: tpawlik1@jhmi.edu

See publication for full list of author contributions.

The authors declare that they have no conflict of interest.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Gastroenterology & Hepatology
  • Surgery
  • Nomogram, perihilar cholangiocarcinoma
  • Risk factors, prognostic tools
  • Survival
  • Hilar cholangiocarcinoma
  • Surgical- treatment
  • Staging system
  • Cancer
  • Survival
  • Nomogram
  • Surgery
  • Liver
  • Gallbladder
  • Validation

A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

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Journal Title:

Journal of Gastrointestinal Surgery

Volume:

Volume 20, Number 10

Publisher:

, Pages 1716-1724

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Introduction: Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC. Methods: Four hundred seven patients who underwent surgery for PHC between 1988 and 2014 were identified using an international, multi-center database. Standard clinicopathologic and outcome data were collected. The predictive power of the AJCC staging system and nomogram were assessed. Results: Median survival was 24.4 months; 3- and 5-year survival was 37.2 and 20.8 %, respectively. The AJCC 7th edition staging system (C-index 0.570) and the recently proposed PHC nomogram (C-index 0.587) both performed poorly. A revised nomogram based on age, lymphovascular invasion, perineural invasion, and lymph node metastases performed better (C-index 0.682). The calibration plot of the revised PHC nomogram demonstrated good calibration. Conclusion: The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.

Copyright information:

© 2016, The Society for Surgery of the Alimentary Tract.

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