A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

• Authors: Stefan Buettner, Johns Hopkins Hospital; Jeroen L. A van Vugt, Erasmus University; Faiz Gani, Johns Hopkins Hospital; Bas Groot Koerkamp, Erasmus University; Georgios Antonios Margonis, Johns Hopkins Hospital; Cecilia G. Ethun, Emory University; George Poultsides, Stanford University; Thuy Tran, Stanford University; Kamran Idrees, Vanderbilt University; Chelsea A. Isom, Vanderbilt University; Ryan C. Fields, Washington University; Bradley Krasnick, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Robert C. G. Martin, University of Louisville; Charles Scoggins, University of Louisville; Perry Shen, Wake Forest University; Harveshp D. Mogal, Wake Forest University; Carl Schmidt, Ohio State University; Eliza Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Shishir Maithel, Emory University; Alfredo Guglielmi, University of Verona; Jan N. M. IJzermans, Erasmus University; Timothy M. Pawlik, Johns Hopkins Hospital
• Journal Title: Journal of Gastrointestinal Surgery
• Volume: Volume 20, Number 10
• Publisher: Springer Verlag (Germany) | 2016-10-01, Pages 1716-1724
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s11605-016-3203-2
• Subjects: Health Sciences, Oncology; Health Sciences, Public Health
• 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

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.