A Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma

Stefan Buettner, Jeroen L A van Vugt, Faiz Gani, Bas Groot Koerkamp, Georgios Antonios Margonis, Cecilia G. Ethun, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza BealIoannis Hatzaras, Rivfka Shenoy, Shishir K. Maithel, Alfredo Guglielmi, Jan N M Ijzermans, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-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.

Original languageEnglish (US)
Pages (from-to)1716-1724
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume20
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • Nomogram, perihilar cholangiocarcinoma
  • Risk factors, prognostic tools
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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