Multicentric evaluation of a clinical and prognostic scoring system predictive of survival after resection of intrahepatic cholangiocarcinomas.
OBJECTIVE
To develop a clinical and prognostic scoring system predictive of survival after resection of intrahepatic cholangiocarcinomas (ICC).


METHODS
Two hundred and one consecutive ICC patients (83 from Essen, Germany, 54 from New York, USA and 64 from Chiba, Japan). The scoring systems were developed utilizing the data set from Essen University and then applied to the data sets from Mount Sinai Medical Center and Chiba University for validation. Eighteen potential prognostic factors were evaluated. Statistical analysis included multivariable regression analyses with the Cox proportional hazard model, power analysis, internal validation with structural equation modelling bootstrapping and external validation. The prognostic scoring model was based mainly in pathological and demographical variables, whereas the clinical scoring model was based mainly in radiological and demographical variables.


RESULTS
Gender (P=0.0086), UICC stage (P=0.0140) and R-class (P=0.0016) were predictive of survival for the prognostic scoring model, while gender (P=0.0023), CA 19-9 levels (P=0.0153) and macrovascular invasion (P=0.0067) were predictive of survival for the clinical scoring model. Prognostic points were assigned as follows: female:male=1:2 points, UICC (I-II):UICC (III-IV)=1:2 points and R0:R1=1:2 points. Clinical points were allocated as follows: female:male=1:2 points, CA 19-9 (<100 U/ml):CA 19-9 (> or =100 U/ml)=1:2 points and no macrovascular invasion:macrovascular invasion=1:2 points. Prognostic groups with 3-4, 5 and 6 points (P=0.000001) and clinical groups with 3-4 and 5-6 points (P=0.0103) achieved statistically significant difference.


CONCLUSIONS
We propose a clinical and prognostic scoring system predictive of long-term survival after surgical resections for ICC.
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. georgios.sotiropoulos@uni-due.de
Georgios C
GC
Sotiropoulos
Masaru
M
Miyazaki
Manousos M
MM
Konstadoulakis
Andreas
A
Paul
Ernesto P
EP
Molmenti
Ilias P
IP
Gomatos
Arnold
A
Radtke
Hideo A
HA
Baba
Susanne
S
Beckebaum
Eirini I
EI
Brokalaki
Masayuki
M
Ohtsuka
Myron E
ME
Schwartz
Christoph E
CE
Broelsch
George
G
Sgourakis
D001650:Bile Duct Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D018281:Cholangiocarcinoma / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D009010:Monte Carlo Method; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009518:New York; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D018395:CA-19-9 Antigen