A nomogram to predict lymph node metastasis before resection in intrahepatic cholangiocarcinoma
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Intrahepatic Cholangiocarcinoma
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Abstract Background Intrahepatic cholangiocarcinoma (ICC) is a malignant neoplasm with a poor prognosis. Prediction of prognosis is critical for the individualized clinical management of patients with ICC. The purpose of this study is to establish a nomogram based on the psoas muscle index (PMI) and prognostic nutritional index (PNI) to identify the high risk-patient with ICC after curative resection. Methods ICC Patients after hepatectomy in multi-hospital from August 2012 to October 2019 were enrolled. The overall survival (OS) and recurrence-free survival (RFS) rates were analyzed by Kaplan-Meier. The independent factors were identified by univariate and multivariate Cox regression analyses. A nomogram based on independent factors was established to predict ICC patient prognosis. Results 178 ICC patients were included. The OS was worst in the patients with a combination of low PMI combined low PNI ( p < 0.01). PMI, PNI, lymph node metastasis and tumor differentiation were the independent prognostic risk factors; these factors were used to establish the nomogram was established by it. The calibration curve revealed that the nomogram survival probability prediction model was in good agreement with the actual observation results. The nomogram has good reliability in predicting ICC patient prognosis (OS C-index = 0.692). The area under the receiver operating characteristic curve (AUC) for the nomogram's 3-year predicted survival was 0.752. Based on the stratified by nomogram, the median survival for low-risk patients was 59.8 months, compared with 16.2 months for high-risk patients ( p ༜0.001). Conclusion The nomogram based on the PMI and PNI can identify patients with the highest risk of poor prognosis after curative hepatectomy. It is a good decision-making tool for individualized treatment.
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Intrahepatic Cholangiocarcinoma
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Single Center
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Abstract Background Hepatectomy with extensive lymph node dissection is the standard operation for intrahepatic cholangiocarcinoma (IHCC). However, lymph node dissection may not always be effective at reducing tumour recurrence. Methods Forty-nine patients with IHCC who underwent hepatectomy were investigated to determine patterns of tumour recurrence and to estimate the value of lymph node dissection during resection. Results At hepatectomy most metastatic lymph nodes were identified at least to the level of group 2 lymph nodes. Among 23 patients who developed recurrence, 17 had liver metastases and the other six had recurrence at other sites, mainly in the peritoneum. Poorly differentiated histology was related to the development of liver metastases. No patient with the intraductal growth type of IHCC had tumour recurrence. Lymph node dissection did not appear to improve patient survival. Histological findings of lymph node metastases and intrahepatic metastases were independent indicators of poor prognosis. Conclusion Lymph node metastases were seldom limited to the regional lymph nodes; most tumour recurrence occurred in the liver. Lymph node dissection did not appear to improve patient survival. Lymph node dissection alone is not likely to improve the prognosis without further control of liver metastases.
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Nomogram
Intrahepatic Cholangiocarcinoma
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Lymphadenectomy
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Liver Cancer
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Objective: To compare the diagnostic accuracy of various transcutaneous bilirubin (TcB) nomograms for predischarge screening. Methods: The paired total serum bilirubin (TSB) and TcB measurements collected in neonates ≥35 weeks and ≥2000 g birth weight were analyzed. BiliCare™ bilirubinometer was used for TcB measurement. We chose the following nomograms for the study: Bhutani nomogram, Maisel's nomogram, Agarwal nomogram, Thakkar nomogram, American Academy of Pediatrics (AAP) nomogram within 3 mg/dl of phototherapy cutoff, AAP nomogram >70% of phototherapy cutoff and if TcB value is above 13 mg/dl. The diagnostic accuracy of these nomograms for TcB was compared with TSB plotted in the Bhutani nomogram. Results: TcB showed a positive correlation with TSB (Pearson correlation coefficient = 0.783). Bhutani nomogram, Maisel's nomogram and AAP (using within 3 mg/dL cutoff) nomogram showed good sensitivity and low false-negative rate while avoiding blood draws in most neonates. Conclusion: Bhutani nomogram, Maisel's nomogram, and AAP (using within 3 mg/dL of phototherapy cutoff) nomograms have comparable diagnostic accuracy for predischarge bilirubin screening in neonates.
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Intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) are the most prevalent histologic types of primary liver cancer (PLC). Although ICC and HCC share similar risk factors and clinical manifestations, ICC usually bears poorer prognosis than HCC. Confidently discriminating ICC and HCC before surgery is beneficial to both treatment and prognosis. Given the lack of effective differential diagnosis biomarkers and methods, construction of models based on available clinicopathological characteristics is in need. Nomograms present a simple and efficient way to make a discrimination. A total of 2894 patients who underwent surgery for PLC were collected. Of these, 1614 patients formed the training cohort for nomogram construction, and thereafter, 1280 patients formed the validation cohort to confirm the model's performance. Histopathologically confirmed ICC was diagnosed in 401 (24.8%) and 296 (23.1%) patients in these two cohorts, respectively. A nomogram integrating six easily obtained variables (Gender, Hepatitis B surface antigen, Aspartate aminotransferase, Alpha-fetoprotein, Carcinoembryonic antigen, Carbohydrate antigen 19-9) is proposed in accordance with Akaike's Information Criterion (AIC). A score of 15 was determined as the cut-off value, and the corresponding discrimination efficacy was sufficient. Additionally, patients who scored higher than 15 suffered poorer prognosis than those with lower scores, regardless of the subtype of PLC. A nomogram for clinical discrimination of ICC and HCC has been established, where a higher score indicates ICC and poor prognosis. Further application of this nomogram in multicenter investigations may confirm the practicality of this tool for future clinical use.
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Intrahepatic Cholangiocarcinoma
Carcinoembryonic antigen
Liver Cancer
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Abstract Background: The aim of the study was to establish and validate nomograms to predict the mortality risk of patients with COVID-19 using routine clinical indicators. Method: This retrospective study included a development cohort enrolled 2119 hospitalized COVID-19 patients and a validation cohort included 1504 COVID-19 patients. The demographics, clinical manifestations, vital signs and laboratory test results of the patients at admission and outcome of in-hospital death were recorded. The independent factors associated with death were identified by a forward stepwise multivariate logistic regression analysis and used to construct two prognostic nomograms. The models were then tested in an external dataset. Results: Nomogram 1 is a full model included nine factors identified in the multivariate logistic regression and nomogram 2 is built by selecting four factors from nine to perform as a reduced model. Nomogram 1 and nomogram 2 established showed better performance in discrimination and calibration than the MuLBSTA score in training. In validation, Nomogram 1 performed better than nomogram 2 for calibration. Conclusion: Nomograms we established performed better than the MuLBSTA score. We recommend the application of nomogram 1 in general hospital which provide robust prognostic performance but more cumbersome; nomogram 2 in mobile cabin hospitals which depend on less laboratory examinations and more convenient. Both nomograms can help clinicians in identifying patients at risk of death with routine clinical indicators at admission, which may reduce the overall mortality of COVID-19.
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We hypothesized that a nomogram can accurately predict overall survival (OS) for patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy.A nomogram to predict OS based was developed using data from 185 ICC patients who had undergone hepatectomy. The nomogram was evaluated by concordance index (C-index), as well as testing calibration of predicted OS with observed OS for both internal and external cohorts.Ten clinicopathological independent factors for OS prediction were selected for use in the nomogram. For internal validation, the calibration curve for probability of OS showed good agreement between prediction by the nomogram and actual observation. In three external validation cohorts, the nomogram discrimination was also superior to two other staging systems.A nomogram integrating ten clinicopathological variables was developed that may assist in individual prognostic prediction of ICC after hepatectomy.
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