AUTHOR=Li Qi , Zhang Jian , Chen Chen , Song Tianqiang , Qiu Yinghe , Mao Xianhai , Wu Hong , He Yu , Cheng Zhangjun , Zhai Wenlong , Li Jingdong , Zhang Dong , Geng Zhimin , Tang Zhaohui 

TITLE=A Nomogram Model to Predict Early Recurrence of Patients With Intrahepatic Cholangiocarcinoma for Adjuvant Chemotherapy Guidance: A Multi-Institutional Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.896764

DOI=10.3389/fonc.2022.896764

ISSN=2234-943X

ABSTRACT=Background: The influence of different postoperative recurrence time on the efficacy of adjuvant chemotherapy (ACT) for intrahepatic cholangiocarcinoma (ICC) remains unclear. This study aimed to investigate the independent risk factors and establish a nomogram prediction model of early recurrence (recurrence within 1 year) to screen patients with ICC for ACT.
Methods: Data from 310 ICC patients who underwent radical resection between 2010 and 2018 at eight Chinese tertiary hospitals was used to analyze the risk factors and establish a nomogram model to predict early recurrence. External validation was conducted from 134 patients at the other two Chinese tertiary hospitals. Overall survival (OS) and relapse-free survival (RFS) were estimated by Kaplan-Meier method. Multivariate analysis was conducted to identify independent risk factors for prognosis. Logistic regression model was used to screen independent risk variables of early recurrence. A nomogram model was established based on the above independent risk variables to predict early recurrence.
Results: ACT was a prognostic factor and an independent affecting factor for OS and RFS of patients with ICC after radical resection (P<0.01). The median OS of ICC patients with non-ACT and ACT was 14.0 months and 15.0 months, and the median RFS was 6.0 months and 8.0 months for early recurrence group, respectively (P>0.05). While the median OS of ICC patients with non-ACT and ACT was 41.0 months and 84.0 months, the median RFS was 20.0 months and 45.0 months for late recurrence group, respectively (P<0.01). CA19-9, tumor size, major vascular invasion, microvascular invasion, and N stage were the independent risk factors of early recurrence for ICC patients after radical resection. The C-index of the nomogram was 0.777 (95%CI:0.713~0.841) and 0.716 (95%CI:0.604~0.828) in the training set and testing set, respectively.
Conclusion: The nomogram model established based on the independent risk variables of early recurrence for curatively resected ICC patients has a good prediction ability and can be used to screen patients benefited from ACT.