Prognostic Nomogram That Predicts Overall Survival of Patients with Distal Cholangiocarcinoma After Pancreatoduodenectomy

Qiao Chen; Jiayi Li; Bao Jin; Xiangan Wu; Yue Shi; Haifeng Xu; Yongchang Zheng; Yingyi Wang; Shunda Du; Xin Lu; Xinting Sang; Yilei Mao

doi:10.2147/CMAR.S276393

Prognostic Nomogram That Predicts Overall Survival of Patients with Distal Cholangiocarcinoma After Pancreatoduodenectomy

Cancer Manag Res. 2020 Oct 20:12:10303-10310. doi: 10.2147/CMAR.S276393. eCollection 2020.

Authors

Qiao Chen^#¹, Jiayi Li^#^{1

2}, Bao Jin¹, Xiangan Wu¹, Yue Shi¹, Haifeng Xu¹, Yongchang Zheng¹, Yingyi Wang³, Shunda Du¹, Xin Lu¹, Xinting Sang¹, Yilei Mao¹

Affiliations

¹ Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
² Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
³ Department of Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: We aimed to develop a nomogram for predicting the prognosis of patients with distal cholangiocarcinoma (DCC) and to compare its performance with that of the American Joint Committee on Cancer (AJCC) TNM system.

Patients and methods: To develop a nomogram, we collected the clinical data of 147 patients diagnosed with DCC who underwent pancreatoduodenectomy. Predictive accuracy and discriminative ability were determined using a concordance index and a calibration curve. Predictive performance was compared with that of a current staging systems for DCC.

Results: Multivariate analysis revealed that jaundice, alcohol consumption, high fibrinogen, poorly differentiated tumor cells, positive lymph nodes, and positive margins were significantly associated with overall survival. These variables were incorporated into the nomogram. The concordance index of the nomogram for predicting overall survival was 0.737 (P<0.001), which is significantly higher than the concordance index values (concordance index = 0.586) acquired using the AJCC TNM system (eighth edition). The calibration curve agreed well with predicted prediction and observed overall survival.

Conclusion: We developed a nomogram for predicting the prognoses of patients with distal cholangiocarcinoma, which had superior practical clinical value compared with that of the AJCC TNM system.

Keywords: distal cholangiocarcinoma; nomograms; pancreatoduodenectomy; prognostic factors; survival analysis.

Grants and funding

This research was supported by National Natural Science Foundation of China (No. 81972698) and Chinese Academy of Medical Sciences Initiative for Innovative Medicine (CAMS-2017-I2M-4-002). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.