TY - JOUR
T1 - Defining when to offer operative treatment for intrahepatic cholangiocarcinoma
T2 - A regret-based decision curves analysis
AU - Bagante, Fabio
AU - Spolverato, Gaya
AU - Cucchetti, Alessandro
AU - Gani, Faiz
AU - Popescu, Irinel
AU - Ruzzenente, Andrea
AU - Marques, Hugo P.
AU - Aldrighetti, Luca
AU - Gamblin, T. Clark
AU - Maithel, Shishir K.
AU - Sandroussi, Charbel
AU - Bauer, Todd W.
AU - Shen, Feng
AU - Poultsides, George A.
AU - Marsh, James Wallis
AU - Guglielmi, Alfredo
AU - Pawlik, Timothy M.
PY - 2016
Y1 - 2016
N2 - Background: Regret-based decision curve analysis (DCA) is a framework that assesses the medical decision process according to physician attitudes (expected regret) relative to disease-based factors. We sought to apply this methodology to decisions around the operative management of intrahepatic cholangiocarcinoma (ICC). Methods: Utilizing a multicentric database of 799 patients who underwent liver resection for ICC, we developed a prognostic nomogram. DCA tested 3 strategies: (1) perform an operation on all patients, (2) never perform an operation, and (3) use the nomogram to select patients for an operation. Results: Four preoperative variables were included in the nomogram: major vascular invasion (HR = 1.36), tumor number (multifocal, HR = 1.18), tumor size (>5 cm, HR = 1.45), and suspicious lymph nodes on imaging (HR = 1.47; all P <.05). The regret-DCA was assessed using an online survey of 50 physicians, expert in the treatment of ICC. For a patient with a multifocal ICC, largest lesion measuring >5 cm, one suspicious malignant lymph node, and vascular invasion on imaging, the 1-year predicted survival was 52% according to the nomogram. Based on the therapeutic decision of the regret-DCA, 60% of physicians would advise against an operation for this scenario. Conversely, all physicians recommended an operation to a patient with an early ICC (single nodule measuring 3 cm, no suspicious lymph nodes, and no vascular invasion at imaging). Conclusion: By integrating a nomogram based on preoperative variables and a regret-based DCA, we were able to define the elements of how decisions rely on medical knowledge (postoperative survival predicted by a nomogram, severity disease assessment) and physician attitudes (regret of commission and omission).
AB - Background: Regret-based decision curve analysis (DCA) is a framework that assesses the medical decision process according to physician attitudes (expected regret) relative to disease-based factors. We sought to apply this methodology to decisions around the operative management of intrahepatic cholangiocarcinoma (ICC). Methods: Utilizing a multicentric database of 799 patients who underwent liver resection for ICC, we developed a prognostic nomogram. DCA tested 3 strategies: (1) perform an operation on all patients, (2) never perform an operation, and (3) use the nomogram to select patients for an operation. Results: Four preoperative variables were included in the nomogram: major vascular invasion (HR = 1.36), tumor number (multifocal, HR = 1.18), tumor size (>5 cm, HR = 1.45), and suspicious lymph nodes on imaging (HR = 1.47; all P <.05). The regret-DCA was assessed using an online survey of 50 physicians, expert in the treatment of ICC. For a patient with a multifocal ICC, largest lesion measuring >5 cm, one suspicious malignant lymph node, and vascular invasion on imaging, the 1-year predicted survival was 52% according to the nomogram. Based on the therapeutic decision of the regret-DCA, 60% of physicians would advise against an operation for this scenario. Conversely, all physicians recommended an operation to a patient with an early ICC (single nodule measuring 3 cm, no suspicious lymph nodes, and no vascular invasion at imaging). Conclusion: By integrating a nomogram based on preoperative variables and a regret-based DCA, we were able to define the elements of how decisions rely on medical knowledge (postoperative survival predicted by a nomogram, severity disease assessment) and physician attitudes (regret of commission and omission).
UR - http://www.scopus.com/inward/record.url?scp=84961885115&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84961885115&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2016.01.023
DO - 10.1016/j.surg.2016.01.023
M3 - Article
C2 - 27046702
AN - SCOPUS:84961885115
SN - 0039-6060
JO - Surgery
JF - Surgery
ER -