Autor(es):
Spolverato, G ; Capelli, G ; Lorenzoni, G ; Gregori, D ; He, J ; Popescu, I ; Pinto Marques, H ; Aldrighetti, L ; Maithel, S ; Pulitano, C ; Bauer, T ; Shen, F ; Poultsides, G ; Soubrane, O ; Martel, G ; Koerkamp, B ; Itaru, E ; Lv, Y ; Pawlik, T
Data: 2022
Identificador Persistente: http://hdl.handle.net/10400.17/4878
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): HCC CIR; Aged; Humans; Bile Duct Neoplasms* / pathology; Bile Ducts, Intrahepatic / pathology; Cholangiocarcinoma* / pathology; Hepatectomy; Neoplasm Recurrence, Local / surgery; Prognosis
Descrição
Background: The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) using landmark analysis. Methods: Patients who underwent curative-intent surgery for ICC from 1999 to 2017 were selected from a multi-institutional international database. A landmark analysis to undertake dynamic overall survival (OS) prediction was performed. A multivariate Cox proportional hazard model was applied to measure the interaction of selected variables with time. The performance of the model was internally cross-validated via bootstrap resampling procedure. Discrimination was evaluated using the Harrell's Concordance Index. Accuracy was evaluated with calibration plots. Results: Variables retained in the multivariable Cox regression OS model included age, tumor size, margin status, morphologic type, histologic grade, T and N category, and tumor recurrence. The effect of several variables on OS changed over time. Results were provided as a survival plot and the predicted probability of OS at the desired time in the future. For example, a 65-year-old patient with an intraductal, T1, grade 3 or 4 ICC measuring 3 cm who underwent an R0 resection had a calculated estimated 3-year OS of 76%. The OS estimate increased if the patient had already survived 1 year (79%). The discrimination ability of the final model was very good (C-index: 0.80). Conclusion: The long-term outcome for patients undergoing curative-intent surgery for ICC should be adjusted based on follow-up time and intervening events. The model in this study showed excellent discriminative ability and performed well in the validation process.
