Prediction of Survival and Analysis of Prognostic Factors for Patients With Combined Hepatocellular Carcinoma and Cholangiocarcinoma: A Population-Based Study

Jitao Wang; Zhi Li; Yong Liao; Jinlong Li; Hui Dong; Hao Peng; Wenjing Xu; Zhe Fan; Fengxiao Gao; Chengyu Liu; Dengxiang Liu; Yewei Zhang

doi:10.3389/fonc.2021.686972

Prediction of Survival and Analysis of Prognostic Factors for Patients With Combined Hepatocellular Carcinoma and Cholangiocarcinoma: A Population-Based Study

Front Oncol. 2021 Jul 16:11:686972. doi: 10.3389/fonc.2021.686972. eCollection 2021.

Authors

Jitao Wang^{1

2}, Zhi Li³, Yong Liao², Jinlong Li², Hui Dong¹, Hao Peng¹, Wenjing Xu¹, Zhe Fan¹, Fengxiao Gao², Chengyu Liu², Dengxiang Liu², Yewei Zhang^{1

4}

Affiliations

¹ School of Medicine, Southeast University, Nanjing, China.
² Xingtai Institute of Cancer Control, Xingtai People's Hospital, Xingtai, China.
³ Department of Infection Management, Xingtai General Hospital of North China Healthcare Group, Xingtai, China.
⁴ Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Background: Combined hepatocellular carcinoma and cholangiocarcinoma (CHC) is an uncommon subtype of primary liver cancer. Because of limited epidemiological data, prognostic risk factors and therapeutic strategies for patients with CHC tend to be individualized. This study aimed to identify independent prognostic factors and develop a nomogram-based model for predicting the overall survival (OS) of patients with CHC.

Methods: We recruited eligible individuals from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 and randomly divided them into the training or verification cohort. Univariate and multivariate analyses were performed to identify independent variables associated with OS. Based on multivariate analysis, the nomogram was established, and its prediction performance was evaluated using the consistency index (C-index) and calibration curve.

Results: In total, 271 patients with CHC were included in our study. The median OS was 14 months, and the 1-, 3-, and 5-year OS rates were 52.3%, 27.1%, and 23.3%, respectively. In the training cohort, multivariate analysis showed that the pathological grade (hazard ratio [HR], 1.26; 95% confidence interval [CI]: 0.96-1.66), TNM stage (HR, 1.21; 95% CI: 1.02 - 1.44), and surgery (HR, 0.26; 95% CI: 0.17 - 0.40) were independent indicators of OS. The nomogram-based model related C-indexes were 0.76 (95% CI: 0.72 - 0.81) and 0.72 (95% CI: 0.66 - 0.79) in the training and validation cohorts, respectively. The calibration of the nomogram showed good consistency of 1-, 3-, and 5-year OS rates between the actual observed survival and predicted survival in both cohorts. The TNM stage (HR, 1.23; 95% CI: 1.01 - 1.49), and M stage (HR, 1.87; 95% CI: 1.14 3.05) were risk factors in the surgical treatment group. Surgical resection and liver transplantation could significantly prolong the survival, with no statistical difference observed.

Conclusions: The pathological grade, TNM stage, and surgery were independent prognostic factors for patients with CHC. We developed a nomogram model, in the form of a static nomogram or an online calculator, for predicting the OS of patients with CHC, with a good predictive performance.

Keywords: Surveillance Epidemiology and End Results database; combined hepatocellular carcinoma and cholangiocarcinoma; nomogram; overall survival; population-based study; prognostic factors.