Prognostic Effect Of Intrahepatic Cholangiocarcinoma Patients Based On Mediation Analysis

Intrahepatic cholangiocarcinoma（ICC）is a primary liver cancer with an incidence second only to hepatocellular carcinoma.In recent years,the incidence of intrahepatic cholangiocarcinoma has shown an upward trend in all regions of the world.However,due to the lack of obvious symptoms and the lack of specific manifestations,patients are often in the middle and late stages at the time of diagnosis and miss the best time to see a doctor.At present,it is clinically advocated that the tumor should be completely removed by surgical radical surgery,and the scope of resection should be planned under the premise of ensuring that the margin of resection is negative and that the remaining liver can compensate the patient’s postoperative liver function.Identifying the stage of the patient at the beginning of the visit can roughly predict the postoperative survival time and provide a reference for postoperative preventive treatment strategies.In addition,the staging will affect the postoperative survival time through the surgical method.While choosing the surgical method,the doctor will determine the resection range and location based on the patient’s staging information,so as to meet the antitumor efficacy as much as possible while avoiding excessive resection of the patient’s organs,thus affecting the patient’s postoperative survival time.However,the extent to which staging directly affects patients’ postoperative risk and indirectly affects postoperative risk through surgical methods is unclear.Based on the data of 2907 patients with intrahepatic cholangiocarcinoma provided by the Eastern Hepatobiliary Hospital Affiliated to the Second Naval Medical University,this study aims to study the influence mechanism of the stage of ICC patients on the prognostic risk of ICC patients.Combined with the opinions of medical experts,this paper constructs a reasonable cause-and-effect diagram with intermediaries.Multicategory logistic regression equations for mediator variables and survival risk equations for outcome variables were fitted separately,and covariates were balanced by mediating probability-weighted ratios.The influence of the stage of patients with intrahepatic cholangiocarcinoma on the prognostic risk is divided into two parts: one is the direct effect of the stage on the prognostic survival time,and the other is the indirect effect of the stage on the prognostic survival time through the intermediary of surgery.The results showed that the effect of initial and advanced patient staging on prognostic risk was mainly attributed to the direct effect of patient staging on prognostic risk,while the indirect effect via surgical approach was partially small.Stages of early and intermediate stage patients contributed more to the indirect effect of prognostic risk than early and late stage patients.