临床预测模型高分文献分享

论文题目

Prognostic Nomogram for Intrahepatic Cholangiocarcinoma After Partial Hepatectomy

论文摘要

Purpose

This study aimed to establish an effective prognostic nomogram for intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy.

Patients and Methods

The nomogram was based on a retrospectively study on 367 patients who underwent partial hepatectomy for ICC at the Eastern Hepatobiliary Surgery Hospital from 2002 to 2007. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve and compared with five currently used staging systems on

ICC. The results were validated using bootstrap resampling and a prospective study on 82 patients operated on from 2007 to 2008 at the same institution.

Results

On multivariate analysis of the primary cohort, independent factors for survival were serum carcinoembryonic antigen, CA 19-9, tumor diameter and number, vascular invasion, lymph node metastasis, direct invasion, and local extrahepatic metastasis, which were all selected into the nomogram. The calibration curve for probability of survival showed good agreement between

prediction by nomogram and actual observation. The C-index of the nomogram for predicting survival was 0.74 (95% CI, 0.71 to 0.77), which was statistically higher than the C-index values of the following systems: American Joint Committee on Cancer (AJCC) seventh edition (0.65), AJCC sixth edition (0.65), Nathan (0.64), Liver Cancer Study Group of Japan (0.64), and Okabayashi (0.67;P <0.001 for all). It was also higher (0.74) in predicting survival for the mass-forming type of ICC (P < 0.001). In the validation cohort, the nomogram discrimination was superior to the five other staging systems (C-index: 0.75 v 0.60 to 0.63; P <0 .001 for all).

Conclusion

The proposed nomogram resulted in more-accurate prognostic prediction for patients with ICC after partial hepatectomy.

分析内容

1

多因素Cox回归模型

2

绘制列线图

3

利用C指数评价模型

4

利用校准图评价模型

5

对模型进行外部验证

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