A novel nomogram for adult primary perihilar cholangiocarcinoma and considerations concerning lymph node dissection

Qi Zhang; Zehan Liu; Shuangqing Liu; Ming Wang; Xinye Li; Jing Xun; Xiangyu Wang; Qin Yang; Ximo Wang; Dapeng Zhang

doi:10.3389/fsurg.2022.965401

A novel nomogram for adult primary perihilar cholangiocarcinoma and considerations concerning lymph node dissection

Front Surg. 2023 Jan 6:9:965401. doi: 10.3389/fsurg.2022.965401. eCollection 2022.

Authors

Qi Zhang^{1

2}, Zehan Liu^{1

3}, Shuangqing Liu¹, Ming Wang³, Xinye Li⁴, Jing Xun^{1

2}, Xiangyu Wang⁵, Qin Yang³, Ximo Wang⁵, Dapeng Zhang^{1

2}

Affiliations

¹ Tianjin Key Laboratory of Acute Abdomen Disease Associated Organ Injury and ITCWM Repair, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
² Integrated Chinese and Western Medicine Hospital, Tianjin University, Tianjin, China.
³ Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China.
⁴ Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵ Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.

Abstract

Objective: To construct a reliable nomogram available online to predict the postoperative survival of patients with perihilar cholangiocarcinoma.

Methods: Data from 1808 patients diagnosed with perihilar cholangiocarcinoma between 2004 and 2015 were extracted from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. They were randomly divided into training and validation sets. The nomogram was established by machine learning and Cox model. The discriminant ability and prediction accuracy of the nomogram were evaluated by concordance index (C-index), receiver operator characteristic (ROC) curve and calibration curve. Kaplan-Meier curves show the prognostic value of the associated risk factors and classification system.

Results: Machine learning and multivariate Cox risk regression model showed that sex, age, tumor differentiation, primary tumor stage(T), lymph node metastasis(N), TNM stage, surgery, radiation, chemotherapy, lymph node dissection were associated with the prognosis of perihilar cholangiocarcinoma patients relevant factors (P < 0.05). A novel nomogram was established. The calibration plots, C-index and ROC curve for predictions of the 1-, 3-, and 5-year OS were in excellent agreement. In patients with stage T1 and N0 perihilar cholangiocarcinoma, the prognosis of ≥4 lymph nodes dissected was better than that of 1- 3 lymph nodes dissected (P < 0.01).

Conclusion: The nomogram prognostic prediction model can provide a reference for evaluating the prognosis and survival rate of patients with perihilar cholangiocarcinoma. Patients with stage T1 and N0 perihilar cholangiocarcinoma have more benefits by increasing the number of lymph node dissection.

Keywords: SEER; lymph node dissection; nomogram; overall survival; perihilar cholangiocarcinoma.