Dynamic Prediction of Survival After Curative Resection of Intrahepatic Cholangiocarcinoma: A Landmarking-Based Analysis.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
07
03
2022
accepted:
16
06
2022
pubmed:
25
7
2022
medline:
14
10
2022
entrez:
24
7
2022
Statut:
ppublish
Résumé
The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) using landmark analysis. Patients who underwent curative-intent surgery for ICC from 1999 to 2017 were selected from a multi-institutional international database. A landmark analysis to undertake dynamic overall survival (OS) prediction was performed. A multivariate Cox proportional hazard model was applied to measure the interaction of selected variables with time. The performance of the model was internally cross-validated via bootstrap resampling procedure. Discrimination was evaluated using the Harrell's Concordance Index. Accuracy was evaluated with calibration plots. Variables retained in the multivariable Cox regression OS model included age, tumor size, margin status, morphologic type, histologic grade, T and N category, and tumor recurrence. The effect of several variables on OS changed over time. Results were provided as a survival plot and the predicted probability of OS at the desired time in the future. For example, a 65-year-old patient with an intraductal, T1, grade 3 or 4 ICC measuring 3 cm who underwent an R0 resection had a calculated estimated 3-year OS of 76%. The OS estimate increased if the patient had already survived 1 year (79%). The discrimination ability of the final model was very good (C-index: 0.80). The long-term outcome for patients undergoing curative-intent surgery for ICC should be adjusted based on follow-up time and intervening events. The model in this study showed excellent discriminative ability and performed well in the validation process.
Sections du résumé
BACKGROUND
BACKGROUND
The current study aimed to develop a dynamic prognostic model for patients undergoing curative-intent resection for intrahepatic cholangiocarcinoma (ICC) using landmark analysis.
METHODS
METHODS
Patients who underwent curative-intent surgery for ICC from 1999 to 2017 were selected from a multi-institutional international database. A landmark analysis to undertake dynamic overall survival (OS) prediction was performed. A multivariate Cox proportional hazard model was applied to measure the interaction of selected variables with time. The performance of the model was internally cross-validated via bootstrap resampling procedure. Discrimination was evaluated using the Harrell's Concordance Index. Accuracy was evaluated with calibration plots.
RESULTS
RESULTS
Variables retained in the multivariable Cox regression OS model included age, tumor size, margin status, morphologic type, histologic grade, T and N category, and tumor recurrence. The effect of several variables on OS changed over time. Results were provided as a survival plot and the predicted probability of OS at the desired time in the future. For example, a 65-year-old patient with an intraductal, T1, grade 3 or 4 ICC measuring 3 cm who underwent an R0 resection had a calculated estimated 3-year OS of 76%. The OS estimate increased if the patient had already survived 1 year (79%). The discrimination ability of the final model was very good (C-index: 0.80).
CONCLUSION
CONCLUSIONS
The long-term outcome for patients undergoing curative-intent surgery for ICC should be adjusted based on follow-up time and intervening events. The model in this study showed excellent discriminative ability and performed well in the validation process.
Identifiants
pubmed: 35871669
doi: 10.1245/s10434-022-12156-1
pii: 10.1245/s10434-022-12156-1
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7634-7641Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Mosconi S, Beretta GD, Labianca R, Zampino MG, Gatta G, Heinemann V. Cholangiocarcinoma. Crit Rev Oncol Hematol. 2009;69:259–70.
doi: 10.1016/j.critrevonc.2008.09.008
Wu L, Tsilimigras DI, Paredes AZ, et al. Trends in the incidence, treatment and outcomes of patients with intrahepatic cholangiocarcinoma in the USA: facility type is associated with margin status, use of lymphadenectomy and overall survival. World J Surg. 2019;43:1777–87.
doi: 10.1007/s00268-019-04966-4
Tsilimigras DI, Sahara K, Wu L, et al. Very early recurrence after liver resection for intrahepatic cholangiocarcinoma: considering alternative treatment approaches. JAMA Surg. 2020;155:823–31.
doi: 10.1001/jamasurg.2020.1973
Tsilimigras DI, Hyer JM, Paredes AZ, et al. Tumor burden dictates prognosis among patients undergoing resection of intrahepatic cholangiocarcinoma: a tool to guide post-resection adjuvant chemotherapy? Ann Surg Oncol. 2021;28:1970–8.
doi: 10.1245/s10434-020-09393-7
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.
doi: 10.1080/01621459.1958.10501452
Cox DR. A note on the graphical analysis of survival data. Biometrika. 1979;66:188–90.
doi: 10.1093/biomet/66.1.188
Bland JM, Altman DG. The log-rank test. BMJ. 2004;328:1073.
doi: 10.1136/bmj.328.7447.1073
Spolverato G, Kim Y, Ejaz A, et al. Conditional probability of long-term survival after liver resection for intrahepatic cholangiocarcinoma: a multi-institutional analysis of 535 patients. JAMA Surg. 2015;150:538–45.
doi: 10.1001/jamasurg.2015.0219
Elfadaly AN, Tsilimigras DI, Hyer JM, et al. Impact of tumor burden score on conditional survival after curative-intent resection for hepatocellular carcinoma: a multi-institutional analysis. World J Surg. 2021;45:3438–48.
doi: 10.1007/s00268-021-06265-3
Kim Y, Margonis GA, Prescott JD, et al. Nomograms to predict recurrence-free and overall survival after curative resection of adrenocortical carcinoma. JAMA Surg. 2016;151:365–73.
doi: 10.1001/jamasurg.2015.4516
Kollman C. Survival analysis and the immortal time bias. JAMA Ophthalmol. 2018;136:1314–5.
doi: 10.1001/jamaophthalmol.2018.3499
Farr AM, Foley K. Landmark analysis to adjust for immortal time bias in oncology studies using claims data linked to death data. Value Health. 2013;16:A50.
doi: 10.1016/j.jval.2013.03.284
AJCC/UICC. TNM Classification of Malignant Tumours. 8th ed. Wiley Blackwell, Chichester, West Sussex, UK, 2017.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Callegaro D, Miceli R, Bonvalot S, et al. Development and external validation of a dynamic prognostic nomogram for primary extremity soft tissue sarcoma survivors. EclinicalMedicine. 2019;17:100215.
doi: 10.1016/j.eclinm.2019.11.008
Huber PJ. The behavior of maximum likelihood estimates under nonstandard conditions. Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability. Vol 1: Statistics. University of California Press, Berkeley, CA, 1967, pp 221–33.
White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48:817–38.
doi: 10.2307/1912934
Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543–6.
doi: 10.1001/jama.1982.03320430047030
Florio AA, Ferlay J, Znaor A, et al. Global trends in intrahepatic and extrahepatic cholangiocarcinoma incidence from 1993 to 2012. Cancer. 2020;126:2666–78.
doi: 10.1002/cncr.32803
Blechacz B. Cholangiocarcinoma: current knowledge and new developments. Gut Liver. 2017;11:13–26.
doi: 10.5009/gnl15568
Spolverato G, Yakoob MY, Kim Y, et al. Impact of complications on long-term survival after resection of intrahepatic cholangiocarcinoma. Cancer. 2015;121:2730–9.
doi: 10.1002/cncr.29419
NCCN. Hepatobiliary Cancers (5.2021), 2021. Retrieved 6 December 2021 at https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf .
Hyder O, Hatzaras I, Sotiropoulos GC, et al. Recurrence after operative management of intrahepatic cholangiocarcinoma. Surgery. 2013;153:811–8.
doi: 10.1016/j.surg.2012.12.005
Hu LS, Zhang XF, Weiss M, et al. Recurrence patterns and timing courses following curative-intent resection for intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2019;26:2549–57.
doi: 10.1245/s10434-019-07353-4
Kim Y, Moris DP, Zhang XF, et al. Evaluation of the 8th-edition American Joint Commission on Cancer (AJCC) staging system for patients with intrahepatic cholangiocarcinoma: a Surveillance, Epidemiology, and End Results (SEER) analysis. J Surg Oncol. 2017;116:643–50.
doi: 10.1002/jso.24720
Gleiss A, Oberbauer R, Heinze G. An unjustified benefit: immortal time bias in the analysis of time-dependent events. Transpl Int. 2018;31:125–30.
doi: 10.1111/tri.13081
Spolverato G, Bagante F, Weiss M, et al. Comparative performances of the 7th and the 8th editions of the American Joint Committee on Cancer staging systems for intrahepatic cholangiocarcinoma. J Surg Oncol. 2017;115:696–703.
doi: 10.1002/jso.24569
Spolverato G, Ejaz A, Kim Y, et al. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2014;18:1284–91.
doi: 10.1007/s11605-014-2533-1
Bagante F, Spolverato G, Weiss M, et al. Impact of morphological status on long-term outcome among patients undergoing liver surgery for intrahepatic cholangiocarcinoma. Ann Surg Oncol. 2017;24:2491–501.
doi: 10.1245/s10434-017-5870-y
Zhang XF, Xue F, Dong DH, et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis. Ann Surg. 2021;274:e1187–95.
doi: 10.1097/SLA.0000000000003788
Hyder O, Marques H, Pulitano C, et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience. JAMA Surg. 2014;149:432–8.
doi: 10.1001/jamasurg.2013.5168
Yuan C, Hu Z, Wang K, Zou S. Development and validation a nomogram for predicting overall survival in patients with intrahepatic cholangiocarcinoma. Front Surg. 2021;8:659422.
doi: 10.3389/fsurg.2021.659422