A novel nomogram for individualized preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma / 中华外科杂志

Objective: Constructing and validating a nomogram model for preoperative prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis to assist decision making during surgery. Methods: Retrospectively collecting the clinical and pathological data of 1 031 ICC patients who underwent partial hepatectomy at Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University,General Hospital of Eastern Theater Command,or Zhongda Hospital Southeast University from January 2003 to January 2014. There were 682 males and 349 females; mean age was 54.7 years(range:18 to 82 years). There were 562 patients who underwent lymph node dissection and 469 patients who did not. Among the patients in the dissection group,Lasso regression method was used to filtrate preoperative variables related to lymph node metastasis and establish a nomogram. Bootstrap method was used to internally validate the discrimination of the nomogram,and the accuracy of the nomogram was assessed by using calibration curves. Patients were divided into low-moderate and high-risk groups based on model prediction probability. Propensity score matching(PSM) was used to analyze the overall survival (OS) and recurrence-free survival (RFS) of patients with and without lymph node dissection in the two groups,and to judge the importance of lymph node dissection in the two groups. Results: Six factors related to ICC lymph node metastasis were determined by Lasso regression,including hepatitis B surface antigen,CA19-9,age,lymphadenopathy,carcinoembryo antigen and maximum tumor diameter. These factors were integrated into a nomogram to predict ICC lymph node metastasis. The aera under curve value was 0.764,and the C-index was 0.754. Stratified analysis showed that OS and RFS in the high-risk group of lymph node metastasis were significantly lower than those in the low-medium risk group(median OS:14.6 months vs. 27.0 months,P<0.01; median RFS:9.1 months vs. 15.5 months,P<0.01). In the high-risk group,the median OS was 16.7 months and 6.3 months(Log-rank test: P=0.187;Wilcoxon test:P=0.046),and the median RFS was 11.0 months and 4.8 months(P=0.403),respectively in the lymph node dissection group and undissected group after PSM. In the low-medium-risk group,the median OS was 22.7 months and 26.7 months(P=0.288),and the median RFS was 13.0 months and 14.5 months(P=0.306),respectively in the lymph node dissection group and undissected group after PSM. Conclusions: The nomogram could be used for preoperative prediction of lymph node metastasis and prognostic stratification in patients with ICC. For patients with high risk of lymph node metastasis predicted by the model,active dissection should be performed. For patients predicted to be at low-moderate risk,lymph node dissection might be optional in some specific cases.

Effect of microvascular invasion on long-term prognosis of liver resection for multiple hepatocellular carcinomas / 医学研究生学报

ObjectiveOnly few studies have been published of the effect of microvascular invasion (MVI) on long-term prognosis of liver resection (LR) for multiple hepatocellular carcinomas (mHCCs). Therefore, we investigate the efficacy of MVI on long-term prognosis of the patients undergoing LR formHCCs.MethodsThe clinical data of 505 patients undergoing LR for mHCCs in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2009 and March 2015 were retrospectively analyzed. Patients were divided into the MVI(+) group （n=279）and MVI (-) group (n=226), and146 patients in MVI (+) group and 124 patients in MVI (-) group received adjuvant transarterial chemoembolization (TACE). The Kaplan-Meier approach was used for survival analysis and the Cox proportional-hazards regression model was used forthe risk factors of long-term survival rate.ResultsThe early recurrence rate of MVI (+) group was significantly higher than that of MVI (-) group (60.4% vs 40.5%, P<0.01), and the 1-, 3-, 5-year overall survival rate of MVI (+) group was significantly lower than those in MVI (-) group (70.5%, 47.4%, 33.4% vs 86.6%, 66.8%, 50.1%, P<0.05). Among MVI (+) patients, the early recurrence rate and 1-, 3-, 5-year overall survival rate in the adjuvant TACE group were better than those in the control group (early recurrence rate 41.3% vs 39.3%, P<0.05; 1, 3, 5 year overall survival rate 92.8%, 72.5%, 53.1% vs 78.6%, 59.5%, 47.3%, P<0.05). Multivariate Cox model indicated that the Alpha-foetoprotein (AFP) level, maximum tumor diameter/minimum tumor diameter, MVI and adjuvant TACE were independent risk factors for early recurrence (HR=1.48, 1.51, 1.34, 0.76, P<0.05); maximum tumor diameter, intraoperative blood transfusion, MVI and adjuvant TACE were independent risk factors for postoperative overall survival (HR=1.75, 1.75, 1.36, 0.68, P<0.05).ConclusionMVI is a risk factor for early recurrence and poor long-term prognosis after LR for mHCCs. For mHCCs with MVI, adjuvant TACE after LR could reduce the early recurrence rate and improve the long-term survival rate.

A predictive risk score model of textbook outcome for patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma / 中国实用外科杂志

OBJECTIVE: To determine the risk factors and develop a risk score model for the textbook outcome(TO)among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma(ICC).METHODS: Theclinicopathological data of 261 ICC patients between January 2011 and January 2017 in Zhongda Hospital of SoutheastUniversity and No.81 Hospital of PLA undergoing partial hepatectomy were retrospectively collected. Logistic regressionanalyses were performed to determine the significant risk factors for predicting TO.RESULTS: A total of 261 patientsundergoing curative-intent resection of ICC were enrolled in the study. Among them,TO was achieved in 67 patients(25.7%). A multivariable logistic regression analysis indicated that older age,non-cirrhosis,reduced operative duration,and T1 a stage disease were independently associated with achieving a TO. A risk score to assess the probability of TOwas developed according the above four risk factors and had good accuracy and satisfactory calibration(χ~2=1.350,P=0.853).CONCLUSION: Younger ICC patients with short operation duration,no cirrhosis,and tumor diameter <5 cm mayhave the higher probability to achieve TO. The risk score model could accurately predict postoperative TO of patientswith ICC.