Establishment of Predictive Model for Survival in Patients with Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Yue ¹ , CHOU Weiping ¹ , GE Chunlin ²

1.Department of Anesthesiology, Liaoning Province Tumor Hospital, Shenyang 110042, Liaoning Province, China;;
2.Department of General Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China;

Corresponding author：

Keywords：

Cholangiocarcinoma; Survival analysis; Prognostic index

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ObjectiveTo establish a predictive model for survival and study it’s clinical value by reviewing the information of patients with hilar cholangiocarcinoma. MethodsMedical record of 196 patients with hilar cholangiocarcinoma were analyzed retrospectively. Seventeen possible clinicopathologic factors were selected. Cox model was used for univariate and multivariate analysis. Prognostic index (PI) was calculated based on the results of multivariate analysis. Patients with different PI were divided into three different risk level groups in order to compare the survival rate. Individual expected survival rate was calculated based on the median PI. Log cumulative hazards function plot was used to test Cox model proportional hazards assumption (PH assumption). ResultsThe significant prognostic factors influencing the survival rate were surgical procedure, surgical margin, and preoperative total bilirubin level (P lt;0.05). The predictive formula was PI=0.815×preoperative total bilirubin level+0.580×surgical margin－0.713×surgical procedure. According to the value of PI, all patients were divided into 3 groups, low risk group (PI≤－0.642), middle risk group (－0.642 lt;PI lt;1.364), high risk group (PI≥1.364), and survival rate declined between groups and in groups with statistically significant difference (P lt;0.05). ConclusionThis model for survival can predict the prognosis of patients with hilar cholangiocarcinoma individually and help to conduct individual clinical therapy.

Citation： WANG Yue ,CHOU Weiping,GE Chunlin. Establishment of Predictive Model for Survival in Patients with Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(6): 590-594. doi: Copy

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1. Chamberlain RS, Blumgart LH. Hilar cholangiocarcinoma: a review and commentary [J]. Ann Surg Oncol, 2000, 7(1): 5566.
2. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma [J]. Ann Surg, 2001, 234(4): 507517.
3. Clary B, Jarnigan W, Pitt H, et al. Hilar cholangiocarcinoma [J]. J Gastrointest Surg, 2004, 8(3): 298302.
4. Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma [J]. Ann Surg, 1992, 215(1): 3138.
5. Lillemoe KD, Cameron JL. Surgery for hilar cholangiocarcinoma: the Johns Hopkins approach [J]. J Hepatobiliary Pancreat Surg, 2000, 7(2): 115121.
6. Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma [J]. Lancet, 2005, 366(9493): 13031314.
7. DeOliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: thirtyoneyear experience with 564 patients at a single institution [J]. Ann Surg, 2007, 245(5): 755762.
8. Hidalgo E, Asthana S, Nishio H, et al. Surgery for hilar cholangiocarcinoma: the Leeds experience [J]. Eur J Surg Oncol, 2008, 34(7): 787794.
9. Han SS, Jang JY, Lee KU, et al. Actual longterm outcome of Klatskin’s tumor after surgical resection [J]. Hepatogastroenterology, 2008, 55(88): 19861992.
10. 孙学军, 石景森, 何平, 等. 影响胆管癌切除术后的预后因素分析 [J]. 中国普外基础与临床杂志, 2006, 13(1): 8588.
11. 程庆保, 张柏和, 张永杰, 等. 肝门部胆管癌预后因素分析 [J]. 肿瘤, 2005, 25(2): 166169.
12. 曾永毅, 林科灿, 池闽辉, 等. 肝门部胆管癌切除术后影响生存率的因素分析 [J]. 腹部外科, 2010, 23(2): 8082.
13. Puhalla H, Gruenberger T, Pokorny H, et al. Resection of hilar cholangiocarcinomas: pivotal prognostic factors and impact of tumor sclerosis [J]. World J Surg, 2003, 27(6): 680684.
14. 郑秀海, 王曙光. 胆管癌浸润转移途径及其机制 [J]. 世界华人消化杂志, 2007, 15(3): 276281.
15. 周少英, 王涛, 武来兴. 肝门部胆管癌的外科诊治分析 [J]. 河北医药, 2010, 32(21): 30183020.
16. 高明, 项和平, 耿小平, 等. 肝门部胆管癌的诊断治疗 [J]. 中国普通外科杂志, 2010, 19(8): 896898.
17. 王海东, 郑进方, 邢贻雷, 等. 肝门部胆管癌手术治疗: 附64例报告 [J]. 中国普通外科杂志, 2007, 16(2): 158160.
18. Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [J]. Ann Surg, 2003, 238(1): 8492.
19. 余红梅, 何大卫. 检查Cox模型比例风险假定的几种图示法 [J] .中国卫生统计, 2000, 17(4): 215218.
20. 华贻军, 洪明晃, 罗东华, 等. 406例鼻咽癌患者预后多因素分析 [J]. 中国肿瘤临床, 2005, 32(8): 435438.
21. 颜笑健, 梁立治, 李道成, 等. 子宫内膜腺鳞癌患者预后的多因素分析 [J]. 肿瘤防治杂志, 2004, 11(6): 643646.
22. AliElDein B, Sarhan O, Hinev A, et al. Superficial bladder tumours: analysis of prognostic factors and construction of a predictive index [J]. BJU Int, 2003, 92(4): 393399.
23. 刘勤，金丕焕, 何大卫. 按PV值分组估计COX模型生存率的剖析 [J]. 中国卫生统计, 1997, 14(1): 46.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Establishment of Predictive Model for Survival in Patients with Hilar Cholangiocarcinoma

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