| Objective(s): The factors affecting the prognosis of patients with intrahepatic cholangiocarcinoma were discussed,and a nomogram was established to predict the overall survival rate of patients with intrahepatic cholangiocarcinomaMethods: The computer search SEER database diagnosed ICC cases from 2005 to 2015.Inclusion criteria:(1)the pathological diagnosis is ICC,if there i s no pathological result,two imaging result are required to diagnose ICC at th e same time;Exclusion Criteria:(1)combined with other tumors;(2)Incomplet e clinical data;(3)The survival time is less than 1 month;(4)Age less than18 years olda.total of 1846 patients were included according to the inclusion criteria,which were divided into training set and validation set according to a7:3 ratio,of which 1294 patients were included in the training set and 552 pat ients were included in the validation set.Patient information was collected incl uding sex,ethnicity,age,tumor diameter,T stage,lymph node surgery informat ion,primary lesion surgery information,lymph node metastasis,and distant met astases.Overall survival is defined as the time between the patient’s diagnosis of ICC and the patient’s death or loss to follow-up.Kaplan-Meier curve was u sed for survival analysis,log-rank test was used,COX univariate and multivari ate analysis was performed on patients using R4.2.1,and the factors with signi ficance of multivariate analysis were incorporated into the nomogram establish ment,and the accuracy of nomogram was evaluated by C-index,calibration cur ve and ROC curve.The test criterion is α=0.05.Results: Of the 1846 patients included in the study,31% of patients with ICC developed lymph node metastases,30% had distant metastases,only 30% had surgery for ICC,and 64% had lymph node dissection.The median survival time of patients in the included studies was 12 months,and the survival rates of 1,3 and 5 years were48.2%,20.5%,and 12.8%,respectively;(2)In the COX univariate analysis,sex(P =0.04),white(P = 0.03),other races(P = 0.01),age < 65 years old(P < 0.01),T2 stage(P < 0.01),T3 stage(P < 0.01),T4 stage(P < 0.01),no surgical treatment(P < 0.01),no lymph node dissection(P < 0.01),lymph node metastasis(P < 0.01);distant metastasis(P < 0.01);Tumor diameter ≥ 5 cm(P < 0.01)correlated with prognosis in ICC patients;The results of COX multivariate analysis showed that white people(0.76,0.60-0.91)and other people(0.70,0.54-0.90)had significantly better prognosis than black people.Age ≥ 65(1.25,1.11-1.41),T2(1.22,1.06-1.41),T3(1.35,1.14-1.58),T4(1.37,1.11-1.70),unoperated(3.41,2.80-4.14),lymph node metastasis(1.16,1.01-1.32),distant metastasis(1.39,1.21-1.60),Tumor diameter ≥ 5 cm(1.15,1.02-1.31)was an independent risk factor affecting OS in ICC patients;The C index of the nomogram was 0.701(95% CI 0.685-0.717),and the OS calibration curves at 1,3 and 5 years showed that the survival rate predicted by the nomogram was in high agreement with the actual survival rate.The areas under the ROC curve of nomogram1,3 and 5 years were 0.78,0.852 and 0.879,respectively,indicating that the prediction ability of nomogram was better;In 552 cases,the internal verification set C index was 0.708(95% CI 0.683-0.733),and the OS calibration curves of 1,3 and 5years showed that the predicted survival rate was in high agreement with the actual survival rate,and the AUCs of 1,3 and 5 years were 0.771,0.83 and 0.898,respectively,indicating that the nomogram still showed good prediction ability in the validation set nomogram;(6)The eighth edition of AJCC staging system predicted that the C index of ICC patients with OS was 0.6160(95% CI 0.598-0.634),while the C index of the nomogram in this study was 0.701,and the AUC of the eighth edition of AJCC staging system predicted that the OS of ICC patients at 1,3 and 5 years was0.647,0.718 and 0.757,respectively,indicating that the prediction ability of the nomogram established in this study was better than that of the eighth version of the AJCC staging system;(7)In the nomogram-based risk grouping study,the OS of the low-risk group was significantly higher than that of the high-risk group(P < 0.01).Conclusion(s):(1)Black people,age ≥ 65 years,T stage,no surgery,lymph node metastasis,distant metastasis,tumor diameter ≥ 5 cm were independent risk factors affecting OS in ICC patients;(2)The nomogram contains variables that are readily available in clinical practice,and the nomogram shows good predictive function in the validation cohort. |
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