Prognostic Factors And Predictive Models For Survival In Patients With Unresectable Intrahepatic Cholangiocarcinoma Treated With Transarterial Chemoembolization

Purpose:Intrahepatic cholangiocarcinoma(ICC)accounts for 10%-15%of primary hepatic malignancies,with occurrence second only to hepatocellular carcinoma(HCC).In recent years,the incidence and mortality of ICC are increasing worldwide.Partial hepatectomy remains the mainstay of curative treatment for ICC.Unfortunately,prognosis after partial hepatectomy is unsatisfactory,with a high incidence of locoregional recurrence and distant metastases.Previous studies showed transarterial chemoembolization(TACE)to be beneficial for patients with advanced and unresectable ICC.We aim to establish an objective risk score system and a predictive nomogram to assess the possibility of prognostic factors for survival in patients with unresectable ICC treated with TACE.Materials and Methods:This retrospective study included all ICC patients receiving TACE therapy between January 2008 and April 2018 in Zhongda Hosptital Southeast University.Independent risk factors associated with overall survival(OS)were identified by univariate and multivariate Cox proportional hazards analyses.The prognostic model as well as the nomogram were then established and internally validated.Results:There were 70 patients included in this study,and the median OS was 11.4 months.The independent predictors of survival derived from univariate and multivariate analyses of the primary cohort were tumor number,extrahepatic spread and Child-Pugh(CP)stage.The prognostic prediction model was established based on the following three independent risk factors associated with OS for patients in the TACE group:number of ICC nodules(2 if<3,lif>3)and CP stage(2 if A,1 if B),extrahepatic spread(0 if yes,1 if no).Patients were divided into two groups by prognostic prediction score of<2.35 and>2.35 in survival benefit(11.8 vs.3.6 months;P<0.001).A nomogram then established based on the three independent risk factors.Calibration curves for survival probability showed that nomogram-based predictions demonstrated good agreement with actual observations.The C-index of the nomogram for predicting survival was 0.73Conclusion:The tumor number,extrahepatic spread and Child-Pugh(CP)stage were independent risk factors.Our prognostic model and predictive nomogram enables accurate prediction of the postoperative survival of patients with unresectable ICC treated with TACE.Unresectable ICC patients with prognostic prediction score<2.35 may benefit most from TACE monotherapy.