Hao Shen1, Shichao Zhang1, Yong Xia1, Can Chen2,3, Lei Huo4, Linhe Gan1,3, Jun Li1, Kui Wang1, Timothy M Pawlik5, Wan Yee Lau1,6, Mengchao Wu7,8, Feng Shen9. 1. Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China. 2. Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, the Union Hospital of Fujian Medical University, Fuzhou, China. 3. Graduate School of Fujian Medical University, Fuzhou, China. 4. Department of Radiology, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, Shanghai, China. 5. Department of Surgery, the Wexner Medical Center of Ohio State University, Columbus, OH, USA. 6. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China. 7. Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China. mcwuehbh@163.com. 8. Graduate School of Fujian Medical University, Fuzhou, China. mcwuehbh@163.com. 9. Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China. shenfengehbh@sina.com.
Abstract
BACKGROUND: Hepatolithiasis is associated with the development of intrahepatic cholangiocarcinoma (ICC). This study sought to investigate risk factors of ICC for hepatolithiasis after partial hepatectomy (PH) and to develop a model for predicting ICC risk. METHODS: Data on consecutive patients who underwent PH for hepatolithiasis at the Eastern Hepatobiliary Surgery Hospital between January 2009 and December 2011 were reviewed. Independent risk factors of ICC identified by Cox regression model were used to develop a nomogram in predicting ICC after PH for hepatolithiasis. RESULTS: Of 2056 patients, 168 developed ICC at a median follow-up of 7.2 years. The cumulative incidences of ICC at 3, 5, and 8 years after PH for hepatolithiasis were 3.0%, 6.5%, and 12.9%, respectively. Independent risk factors of ICC were identified to be a long duration of hepatolithiasis-related symptoms (hazard ratio, 1.088 [95% confidence interval, 1.057-1.120]), metabolic syndrome (2.036 [1.210-3.425]), a high neutrophil-to-lymphocyte ratio (1.250 [1.009-2.816] for 3-5 vs ≤3; 1.538 [1.048-2.069] for ≥5 vs ≤3), hepatic atrophy (1.711 [1.189-2.462]), segmental intensity differences (1.513 [1.052-2.176]), persistent biliary strictures (2.825 [1.480-5.391]), and residual stone disease (2.293 [1.511-3.481]). By incorporating these factors, a constructed nomogram showed a concordance index of 0.721 to predict ICC. The calibration plots demonstrated good agreement between observed and predicted morbidities. The optimal cutoff point for the nomogram was 48 in differentiating between high and low-risk of ICC. CONCLUSIONS: A nomogram for predicting ICC after PH for hepatolithiasis was constructed based on risk factors of developing ICC. Patients with a nomogram point of ≥48 were predicted to have a high risk of ICC.
BACKGROUND: Hepatolithiasis is associated with the development of intrahepatic cholangiocarcinoma (ICC). This study sought to investigate risk factors of ICC for hepatolithiasis after partial hepatectomy (PH) and to develop a model for predicting ICC risk. METHODS: Data on consecutive patients who underwent PH for hepatolithiasis at the Eastern Hepatobiliary Surgery Hospital between January 2009 and December 2011 were reviewed. Independent risk factors of ICC identified by Cox regression model were used to develop a nomogram in predicting ICC after PH for hepatolithiasis. RESULTS: Of 2056 patients, 168 developed ICC at a median follow-up of 7.2 years. The cumulative incidences of ICC at 3, 5, and 8 years after PH for hepatolithiasis were 3.0%, 6.5%, and 12.9%, respectively. Independent risk factors of ICC were identified to be a long duration of hepatolithiasis-related symptoms (hazard ratio, 1.088 [95% confidence interval, 1.057-1.120]), metabolic syndrome (2.036 [1.210-3.425]), a high neutrophil-to-lymphocyte ratio (1.250 [1.009-2.816] for 3-5 vs ≤3; 1.538 [1.048-2.069] for ≥5 vs ≤3), hepatic atrophy (1.711 [1.189-2.462]), segmental intensity differences (1.513 [1.052-2.176]), persistent biliary strictures (2.825 [1.480-5.391]), and residual stone disease (2.293 [1.511-3.481]). By incorporating these factors, a constructed nomogram showed a concordance index of 0.721 to predict ICC. The calibration plots demonstrated good agreement between observed and predicted morbidities. The optimal cutoff point for the nomogram was 48 in differentiating between high and low-risk of ICC. CONCLUSIONS: A nomogram for predicting ICC after PH for hepatolithiasis was constructed based on risk factors of developing ICC. Patients with a nomogram point of ≥48 were predicted to have a high risk of ICC.