title: Adjuvant Transarterial Chemoembolization Following Liver Resection for Intrahepatic Cholangiocarcinoma Based on Survival Risk Stratification.
abstract: BACKGROUND
  The effectiveness of adjuvant transarterial chemoembolization (TACE) for intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study was performed to identify ICC patients who would benefit from adjuvant TACE.
  
  
  METHODS
  The study included 553 patients who underwent hepatectomy for ICC between January 2008 and February 2011 at the Eastern Hepatobiliary Surgery Hospital and who were treated with or without TACE (122 with TACE and 431 without TACE). Survival risk stratification was performed using the established prognostic nomogram (ICC nomogram). The predictive performance was evaluated by concordance index and calibration. The tumor recurrence and overall survival (OS) rates were analyzed by the Kaplan-Meier method before and after propensity score matching (PSM).
  
  
  RESULTS
  The predictive performance of the ICC nomogram was demonstrated by the well-fitted calibration curves and an optimal c-index of 0.71 for OS prediction. In the whole cohort, the 5-year recurrence and OS rates between the TACE and non-TACE groups were significantly different (5-year recurrence: 72.9% vs. 78.1%; OS: 38.4% vs. 29.7%). After 1:1 PSM, the TACE and non-TACE groups (122 patients each) had similar 5-year recurrence and OS rates (5-year recurrence: 72.9% vs. 74.2%; OS: 38.4% vs. 36.0%). By survival risk stratification based on ICC nomogram, only the patients in the lowest tertile (nomogram scores ≥77) benefited from adjuvant TACE (TACE vs. non-TACE groups: 90.4% vs. 95.9% for 5-year recurrence; 21.3% vs. 6.2% for 5-year OS).
  
  
  CONCLUSIONS
  Adjuvant TACE following liver resection might be suitable for ICC patients with high ICC nomogram scores (≥77).
  
  
  CONCLUSIONS
  The accurate predictive performance of the established prognostic nomogram for intrahepatic cholangiocarcinoma (ICC) following liver resection was reconfirmed in an independent cohort with 553 patients. Based on the survival risk stratification using the nomogram, adjuvant transarterial chemoembolization following liver resection might be suitable only for ICC patients with high scores from the nomogram.
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Zhengqing
authors.initials: Z
authors.lastname: Lei
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Dong
authors.initials: D
authors.lastname: Wu
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Anfeng
authors.initials: A
authors.lastname: Si
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Kui
authors.initials: K
authors.lastname: Wang
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Xuying
authors.initials: X
authors.lastname: Wan
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Yizhou
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Zhenlin
authors.initials: Z
authors.lastname: Yan
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China.
authors.forename: Mengchao
authors.initials: M
authors.lastname: Wu
authors.affiliation: Departments of Hepatic Surgery and Chinese Traditional Medicine, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People's Republic of China; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China shenfengehbh@sina.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D004659:Enbucrilate / Q000008:administration & dosage / Q000031:analogs & derivatives; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors
chemical_list: C493949:hydroxycamptothecin polybutylcyanoacrylate; D015251:Epirubicin; D004659:Enbucrilate; D005472:Fluorouracil
keywords: Adjuvant transarterial chemoembolization; Hepatectomy; Intrahepatic cholangiocarcinoma; Prognosis