Stefan Buettner1,2, Jeroen L A van Vugt2, Faiz Gani1, Bas Groot Koerkamp2, Georgios Antonios Margonis1, Cecilia G Ethun3, George Poultsides4, Thuy Tran4, Kamran Idrees5, Chelsea A Isom5, Ryan C Fields6, Bradley Krasnick6, Sharon M Weber7, Ahmed Salem7, Robert C G Martin8, Charles Scoggins8, Perry Shen9, Harveshp D Mogal9, Carl Schmidt10, Eliza Beal10, Ioannis Hatzaras11, Rivfka Shenoy11, Shishir K Maithel3, Alfredo Guglielmi12, Jan N M IJzermans2, Timothy M Pawlik13. 1. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. 2. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. 3. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 4. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 5. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 7. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 8. Department of Surgery, University of Louisville, Louisville, KY, USA. 9. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 10. Department of Surgery, Ohio State University, Columbus, OH, USA. 11. Department of Surgery, New York University, New York, NY, USA. 12. Department of Surgery, Verona University Medical Center, Verona, Italy. 13. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA. tpawlik1@jhmi.edu.
Abstract
INTRODUCTION: Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC. METHODS: Four hundred seven patients who underwent surgery for PHC between 1988 and 2014 were identified using an international, multi-center database. Standard clinicopathologic and outcome data were collected. The predictive power of the AJCC staging system and nomogram were assessed. RESULTS: Median survival was 24.4 months; 3- and 5-year survival was 37.2 and 20.8 %, respectively. The AJCC 7th edition staging system (C-index 0.570) and the recently proposed PHC nomogram (C-index 0.587) both performed poorly. A revised nomogram based on age, lymphovascular invasion, perineural invasion, and lymph node metastases performed better (C-index 0.682). The calibration plot of the revised PHC nomogram demonstrated good calibration. CONCLUSION: The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.
INTRODUCTION: Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC. METHODS: Four hundred seven patients who underwent surgery for PHC between 1988 and 2014 were identified using an international, multi-center database. Standard clinicopathologic and outcome data were collected. The predictive power of the AJCC staging system and nomogram were assessed. RESULTS: Median survival was 24.4 months; 3- and 5-year survival was 37.2 and 20.8 %, respectively. The AJCC 7th edition staging system (C-index 0.570) and the recently proposed PHC nomogram (C-index 0.587) both performed poorly. A revised nomogram based on age, lymphovascular invasion, perineural invasion, and lymph node metastases performed better (C-index 0.682). The calibration plot of the revised PHC nomogram demonstrated good calibration. CONCLUSION: The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.
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