JCO：第二军医大学东方肝胆外科医院沈锋等建立的列线图模型可有效评估肝内胆管癌预后

在2013年3月20日出版的《临床肿瘤学杂志》(Journal of Clinical Oncology)上，发表了我国第二军医大学东方肝胆外科医院沈峰教授等人的一项研究结果，该研究针对接受部分肝切除治疗后的肝内胆管癌(ICC)患者，旨在建立一种有效的预后列线图。

研究人员根据367例ICC患者完成了该列线图，这些患者曾于2002年至2007年间，在东方肝胆外科医院接受了部分肝切除治疗。根据一致性指数(C-指数)以及校正曲线，确定列线图的预测准确度及判别能力，并将其与现行的5类ICC分期系统进行对比。此外通过自引重取样方法，以及对2007年至2008年间，在同机构接受手术治疗的82例患者进行的前瞻性研究，对上述列线图结果进行验证。

针对初始队列进行的多变量分析显示，生存相关独立因素为血浆癌胚抗原、CA 19-9、瘤体直径及数目、血管侵犯、淋巴结转移、直接侵犯以及局部肝外转移，这些参数均被纳入到列线图之中。生存概率的校正曲线表明，列线图预测结果与实际观察结果契合良好。列线图中与预测生存相关的C-指数为0.74 (95% CI, 0.71至 0.77)，该结果在统计学意义上高于以下系统中的C-指数：美国癌症联合委员会(AJCC)第七版(0.65)、AJCC第六版(0.65)、Nathan系统(0.64)、日本肝癌研究组(0.64)、以及Okabayashi系统(0.67; 所有P < .001)。肿块型ICC的生存预测结果也较高(0.74, P < .001)。最终的验证队列结果表明，列线图的判别能力优于其他5类分期系统(C-指数: 0.75 v 0.60 至0.63;所有 P < .001)。

沈教授等人最终认为，对于接受部分肝切除治疗后的ICC患者预后情况，可通过这项研究所推荐的列线图得到更为准确的预测结果。

与胆管癌相关的拓展阅读：

• J Clin Invest.：胆管癌可起源于肝细胞
• Gastroenterology：新辅助化放疗序贯肝移植对肝门部胆管癌有效
• Nat Genetics：与肝吸虫有关胆管癌的外显子测序结果公布
• 肝门胆管癌普通外科临床路径（2011年版） 更多信息请点击：有关胆管癌更多资讯

Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy.
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 < .001 for all). It was also higher (0.74) in predicting survival for the mass-forming type of ICC (P < .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 < .001 for all).
CONCLUSION
The proposed nomogram resulted in more-accurate prognostic prediction for patients with ICC after partial hepatectomy.