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Oncotarget. 2016 Jun 14;7(24):37319-37330. doi: 10.18632/oncotarget.9104.

Establishment and validation of a prognostic nomogram for patients with resectable perihilar cholangiocarcinoma.

Chen P1, Li B1,2,3, Zhu Y4, Chen W5, Liu X5, Li M1, Duan X1, Yi B2,3, Wang J6, Liu C2,3, Luo X2,3, Li X1, Li J1, Liang L5, Yin X5, Wang H1,7,8, Jiang X2,3.

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Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, P. R. China.
Biliary Tract Surgery Department I, Eastern Hepatobiliary Surgery Hospital, Secondary Military Medical University, Shanghai, 200433, P. R. China.
Diagnosis and Treatment Center of Malignant Biliary Tract Diseases, Secondary Military Medical University, Shanghai, 200433, P. R. China.
Department of Pathology, Changhai Hospital, Secondary Military Medical University, Shanghai, 200433, P. R. China.
Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, P. R. China.
Department of Hepatobiliary Surgery, Navy General Hospital, 100048, P. R. China.
Key Laboratory of Food Safety Risk Assessment, Ministry of Health, Beijing, 100021, P. R. China.
School of Life Science and Technology, ShanghaiTech University, Shanghai, 200031, P. R. China.


As the conventional staging systems have poor prognosis prediction ability for patients with perihilar cholangiocarcinoma (pCCA), we established and validated an effective prognostic nomogram for pCCA patients based on their personal and tumor characteristics. A total of 235 patients who received curative intent resections at the Eastern Hepatobiliary Surgery Hospital from 2000 to 2009 were recruited as the primary training cohort. Age, preoperative CA19-9 levels, portal vein involvement, hepatic artery invasion, lymph node metastases, and surgical treatment outcomes (R0 or R1/2) were independent prognostic factors for pCCA patients in the primary cohort as suggested by the multivariate analyses and these were included in the established nomogram. The calibration curve showed good agreement between overall survival probability of pCCA patients for the nomogram predictions and the actual observations and the concordance index (C-index) was 0.68 (95% CI, 0.61-0.71). The C-index values and time-dependent ROC tests suggested that the nomogram is superior to the conventional staging systems including the Bismuth-Corlette, Gazzaniga, Memorial Sloan Kettering Cancer Center (MSKCC), American Joint Committee on Cancer (AJCC) TNM 7th edition, and Mayo Clinic. The nomogram also performed better than the traditional staging system in the internal cohort with 93 pCCA patients from the same institution and an external validation cohort including 84 pCCA patients from another institution in predicting the overall survival of the pCCA patients as suggested by the C-index values and the time-dependent ROC tests. In summary, the proposed nomogram has superior predictive accuracy of prognosis for resectable pCCA patients.


nomogram; overall survival; perihilar cholangiocarcinoma

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