A nomogram to predict lymph node metastasis before resection in intrahepatic cholangiocarcinoma
A nomogram to predict lymph node metastasis before resection in intrahepatic cholangiocarcinoma
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DOI：
10.1016/j.jss.2018.01.024
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发表时间：
2018-06-01
影响因子：
2.2
通讯作者：
Chen, Yan-Ling
中科院分区：
文献类型：
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作者：
Meng, Ze-Wu;Lin, Xiu-Quan;Chen, Yan-Ling
背景：在本研究中，我们建立并验证了预测肝内胆管癌术前淋巴结转移的诺模图。方法：利用2006年1月至2015年1月的数据，我们招募了218名符合条件的经临床病理证实的肝内胆管癌术前淋巴结转移预测诺模图作为主要队列。在对术前各变量进行多因素Logistic回归分析后，我们结合术前糖类抗原19-9、肿瘤原发部位、CT上的淋巴结大小、肿瘤生长类型以及(如果适用)组织学分级，得到两种不同的预测诺模图。然后，从2015年2月到2016年12月，在连续62名ICC患者中验证了结果。结果：诺模图在初级队列中表现出良好的区分度(一致性指数为0.761)和精细校正。当应用于验证队列时，诺模图也显示出良好的区分性(一致性指数，0.794)和精细校准。在将组织学分级添加到诺模图后，对预测性能的综合判别率显著提高。结论：所提出的预测诺模图可以有选择地用于更准确地预测ICC患者的术前淋巴结转移，为临床治疗提供帮助。(C)2018 Elsevier Inc.保留所有权利。
Background: In this study, we developed and validated a nomogram to predict lymph node metastasis before surgery in patients with intrahepatic cholangiocarcinoma (ICC).Methods: Using the data from January 2006 to January 2015, we enrolled a total of 218 eligible patients with clinicopathologically confirmed ICC as a primary cohort to develop the nomogram. After various variables before surgery were analyzed by multivariable logistic regression, we combined the preoperative carbohydrate antigen 19- 9, primary site of tumor, lymphonodus size on computed tomography imaging, tumor growth pattern, and (if applicable) histologic grade to make two different predictive nomograms. Then, the results were validated in 62 consecutive ICC patients from February 2015 to December 2016. We also compared the performance of the different nomograms via calibration, discrimination, and clinical use.Results: The nomogram displayed fine discrimination (the concordance index, 0.761) and fine calibration in the primary cohort. When applied to the validation cohort, the nomogram also showed fine discrimination (concordance index, 0.794) and fine calibration. After adding the histologic grade to the nomogram, the integrated discrimination for predictive performance improved significantly. Finally, the clinical usefulness of predictive nomogram was proven via the decision curve analysis.Conclusions: The proposed nomograms can be selectively used to achieve more accurate lymph node metastasis predictions before surgery in patients with ICC, and this information can help with clinical management. (C) 2018 Elsevier Inc. All rights reserved.