title: Risk stratification and prognostic nomogram for post-recurrence overall survival in patients with recurrent extrahepatic cholangiocarcinoma.
abstract: This study aimed to investigate post-recurrence overall survival (PROS) in patients with recurrent extrahepatic cholangiocarcinoma (EHC) and to indicate which groups of patients need active salvage treatments.
  
  
  
  We retrospectively reviewed the records of 251 consecutive patients who underwent curative surgery followed by adjuvant chemoradiotherapy for EHC. Among these, 144 patients experienced a recurrence and were included for further analysis.
  
  
  
  The median PROS was 7 months (range, 1-130). In multivariate analysis, poorly differentiated histology, short disease-free survival, poor performance status, and elevated CA 19-9 were identified as significant prognosticators for poor PROS. Based on this, we stratified study patients into three categories by the number of risk factors: group 1 (0 or 1 factors), group 2 (2 factors) and group 3 (3-4 factors). Median PROS for groups 1, 2, and 3 were 13, 7, and 5 months, respectively (p < 0.001). Group 1 patients showed a significant benefit from salvage treatment, but groups 2 and 3 did not demonstrate clear benefit. In addition, we developed a nomogram to specifically identify individual patient's prognosis.
  
  
  
  Our simple risk stratification as well as proposed nomogram can classify patients into subgroups with different prognosis and will help facilitate personalized strategies after recurrence.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, South Korea.
authors.forename: Byoung Hyuck
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, South Korea. Electronic address: kyubokim.ro@gmail.com.
authors.forename: Kyubo
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Eui Kyu
authors.initials: EK
authors.lastname: Chie
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Chungnam National University Hospital, Daejeon, South Korea.
authors.forename: Jeanny
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sun Whe
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Do-Youn
authors.initials: DY
authors.lastname: Oh
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Yung-Jue
authors.initials: YJ
authors.lastname: Bang
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D049451:Nomograms; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome