Evidence map›Paper›PMID 29352440›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2018

The Limitations of Standard Clinicopathologic Features to Accurately Risk-Stratify Prognosis after Resection of Intrahepatic Cholangiocarcinoma.

Fabio Bagante, Katiuscha Merath, Malcolm H Squires, Matthew Weiss, Sorin Alexandrescu, Hugo P Marques, Luca Aldrighetti, Shishir K Maithel, Carlo Pulitano, Todd W Bauer and 8 more

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In one paragraph

Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Surgical resection of lymph node positive intrahepatic cholangiocarcinoma may not improve survival.HPB : the official journal of the International Hepato Pancreato Biliary Association · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Fabio BaganteDepartment of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
Katiuscha MerathDepartment of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
Malcolm H SquiresDepartment of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA.
Matthew WeissDepartment of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Sorin AlexandrescuDepartment of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
Hugo P MarquesDepartment of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
Luca AldrighettiDepartment of Surgery, Ospedale San Raffaele, Milan, Italy.
Shishir K MaithelDepartment of Surgery, Emory University, Atlanta, GA, USA.
Carlo PulitanoDepartment of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
Todd W BauerDepartment of Surgery, University of Virginia, Charlottesville, VA, USA.
Feng ShenDepartment of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
George A PoultsidesDepartment of Surgery, Stanford University, Stanford, CA, USA.
Olivier SoubraneDepartment of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France.
Guillaume MartelDivision of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
B Groot KoerkampDepartment of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
Alfredo GuglielmiDepartment of Surgery, University of Verona, Verona, Italy.
Endo ItaruGastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan.
Timothy M PawlikDepartment of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe ability to provide accurate prognostic data after hepatectomy for intrahepatic cholangiocarcinoma (ICC) remains poor. We sought to develop and validate a nomogram to predict survival, as well as investigate the clinical implications of underestimating patients' risk of recurrence.

methodsPatients undergoing curative-intent resection of ICC between 1990 and 2015 at 14 major hepatobiliary centers were included. Variables significant on multivariable analysis were used to construct a nomogram to predict disease-free survival (DFS). The nomogram assigned a score to each variable included in the model and calculated the risk of recurrence.

resultsEight hundred ninety-seven patients are included in the analytic cohort. On multivariable Cox regression analysis, tumor size > 5 cm (HR 1.98, 95% CI 1.44-2.13; p < 0.001), multifocal ICC (HR 1.64, 95% CI 1.32-2.03; p < 0.001), lymph node metastasis (HR 1.63, 95% CI 1.25-2.11; p < 0.001), poorly differentiated tumor grade (HR 1.50, 95% CI 1.21-1.89; p < 0.001), and periductal infiltrating type (PI) morphology (HR 1.42, 95% CI 1.09-1.83; p = 0.008) were independent adverse risk factors associated with decreased DFS. The Harrell's c-index for the nomogram was 0.633 (with n = 5000 bootstrapping resamples) and the plot comparing predicted and actuarial DFS demonstrated a good calibration of the model. A subset of patients (n = 282) had a DFS worse than predicted (ΔPredicted DFS - Actuarial DFS > 6 months). Moreover, underestimation of a recurrence risk was more common among patients with clinicopathologic features traditionally considered "favorable."

conclusionA nomogram based on standard clinicopathologic characteristics was suboptimal in its ability to predict accurately risk of recurrence among patients with ICC after curative-intent liver resection. Particularly, the risk of underestimating patient risk of recurrence was highest among patients with historically favorable characteristics. Over one third of patients recurred > 6 months earlier than the DFS predicted by the nomogram.

Indexed as

Neoplasm Recurrence, LocalNomogramsAgedBile Duct NeoplasmsCholangiocarcinomaDisease-Free SurvivalFemaleHepatectomyHumansLymphatic MetastasisMaleMiddle AgedNeoplasm GradingRisk AssessmentRisk FactorsDrs. Bagante and Merath equally contributed to this manuscript.ICCNomogramRecurrenceSurgerySurvival

Identifiers

PMID29352440

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.