A nomogram for preoperative prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma based on inflammation-related markers.
10.3760/cma.j.cn112139-20230106-00009
- Author:
Xiao Peng YU
1
;
Jia Lu CHEN
1
;
Yue TANG
1
;
Chen CHEN
2
;
Ying Hong QIU
3
;
Hong WU
4
;
Tian Qiang SONG
5
;
Yu HE
6
;
Xian Hai MAO
7
;
Wen Long ZHAI
8
;
Zhang Jun CHENG
9
;
Xiao LIANG
10
;
Jing Dong LI
11
;
Chuan Dong SUN
12
;
Kai MA
12
;
Rui Xin LIN
13
;
Zhi Min GENG
2
;
Zhao Hui TANG
1
;
Zhi Wei QUAN
1
Author Information
1. Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China.
2. Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China.
3. Department of Biliary Surgery, the Third Affiliated Hospital of to Naval Medical University,Shanghai 200433,China.
4. Department of Liver Surgery,West China Hospital of Sichuan University,Chengdu 610041,China.
5. Department of Hepatobiliary Oncology,Tianjin Medical University Cancer Hospital,Tianjin 300060,China.
6. Department of Hepatobiliary Surgery,the Southwest Hospital of Army Medical University,Chongqing 400038,China.
7. Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,Changsha 410005,China.
8. Department of Hepatobiliary Pancreas and Liver Transplantation Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China.
9. Department of Hepatobiliary and Pancreatic Surgery,Zhongda Hospital, Southeast University,Nanjing 210009,China.
10. Department of Hepatobiliary and Pancreatic Surgery,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310020,China.
11. Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China.
12. Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China.
13. Department of Hepatobiliary and Pancreatic Surgery,the Second Norman Bethune Hospital of Jilin University,Changchun 130041,China.
- Publication Type:Journal Article
- From:
Chinese Journal of Surgery
2023;61(4):321-329
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To construct a nomogram for prediction of intrahepatic cholangiocarcinoma (ICC) lymph node metastasis based on inflammation-related markers,and to conduct its clinical verification. Methods: Clinical and pathological data of 858 ICC patients who underwent radical resection were retrospectively collected at 10 domestic tertiary hospitals in China from January 2010 to December 2018. Among the 508 patients who underwent lymph node dissection,207 cases had complete variable clinical data for constructing the nomogram,including 84 males,123 females,109 patients≥60 years old,98 patients<60 years old and 69 patients were pathologically diagnosed with positive lymph nodes after surgery. Receiver operating characteristic curve was drawn to calculate the accuracy of preoperative imaging examinations to determine lymph node status,and the difference in overall survival time was compared by Log-rank test. Partial regression squares and statistically significant preoperative variables were screened by backward stepwise regression analysis. R software was applied to construct a nomogram,clinical decision curve and clinical influence curve,and Bootstrap method was used for internal verification. Moreover,retrospectively collecting clinical information of 107 ICC patients with intraoperative lymph node dissection admitted to 9 tertiary hospitals in China from January 2019 to June 2021 was for external verification to verify the accuracy of the nomogram. 80 patients with complete clinical data but without lymph node dissection were divided into lymph node metastasis high-risk group and low-risk group according to the score of the nomogram among the 858 patients. Log-rank test was used to compare the overall survival of patients with or without lymph node metastasis diagnosed by pathology. Results: The area under the curve of preoperative imaging examinations for lymph node status assessment of 440 patients was 0.615,with a false negative rate of 62.8% (113/180) and a false positive rate of 14.2% (37/260). The median survival time of 207 patients used to construct a nomogram with positive or negative postoperative pathological lymph node metastases was 18.5 months and 27.1 months,respectively (P<0.05). Five variables related to lymph node metastasis were screened out by backward stepwise regression analysis,which were combined calculi,neutrophil/lymphocyte ratio,albumin,liver capsule invasion and systemic immune inflammation index,according to which a nomogram was constructed with concordance index(C-index) of 0.737 (95%CI: 0.667 to 0.806). The C-index of external verification was 0.674 (95%CI:0.569 to 0.779). The calibration prediction curve was in good agreement with the reference curve. The results of the clinical decision curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.32,the maximum net benefit could be obtained by 0.11,and the cost/benefit ratio was 1∶2. The results of clinical influence curve showed that when the risk threshold of high lymph node metastasis in the nomogram was set to about 0.6,the probability of correctly predicting lymph node metastasis could reach more than 90%. There was no significant difference in overall survival time between patients with high/low risk of lymph node metastasis assessed by the nomogram and those with pathologically confirmed lymph node metastasis or without lymph node metastasis (Log-rank test:P=0.082 and 0.510,respectively). Conclusion: The prediction accuracy of preoperative nomogram for ICC lymph node metastasis based on inflammation-related markers is satisfactory,which can be used as a supplementary method for preoperative diagnosis of lymph node metastasis and is helpful for clinicians to make personalized decision of lymph node dissection for patients with ICC.
