Transarterial chemoembolization versus percutaneous microwave coagulation therapy for recurrent unresectable intrahepatic cholangiocarcinoma:Development of a prognostic nomogram

Background:Transarterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT)are commonly used to treat intrahepatic recurrent liver cancers.However,there is no informa-tion regarding their effectiveness in patients with recurrent intrahepatic cholangiocarcinoma(ICC)after resection.Methods:A total of 275 patients with localized recurrent ICC who received either TACE(n=183)or PMCT(n=92)were studied.A propensity score matching analysis was performed to compare prognostic impact of TACE and PMCT.Prognostic factors for TACE and PMCT were identified respectively.Predictive nomograms for each TACE and PMCT were developed using the Cox independent prognostic factors and were validated in independent patient groups by receiver operating characteristic curves and area under curve values.Results:Both TACE and PMCT provided curativeness in partial patients(5-year overall survival:21.4%and 6.1%,respectively),but TACE provided better survival benefit in both overall patients(hazard ratio[HR]=0.71;95%confidence interval[CI]:0.50–0.97;P=0.034)and propensity score matching analysis(HR=0.69;95%CI:0.47–0.98;P=0.041).Independent prognostic factors for TACE were tumor size>5 cm,poor differentiation,and major resection,whereas poor differentiation,hepatitis B virus infection,cholelithiasis,and lymph node metastasis were identified for PMCT.Both predictive nomograms for TACE and PMCT were validated to be effective with area under curve values of 0.77 and 0.70,respectively.Conclusions:TACE provided better survival benefits compared to PMCT.However,there was a disparity in prognostic factors,suggesting evaluation of the two nomograms may be supportive in modality selection.Further prospective validation studies are required for the results to be applied in clinical medicine.

A combined Cox and logistic model provides accurate predictive performance in estimation of time-dependent probabilities for recurrence of intrahepatic cholangiocarcinoma after resection

HepatoBiliary Surg Nutr 2021;10(4):464-475|http://dx.doi.org/10.21037/hbsn.2020.01.07 Original Article A combined Cox and logistic model provides accurate predictive performance in estimation of time-dependent probabilities for recurrence of intrahepatic cholangiocarcinoma after resection Seogsong Jeong1,2#,Guijuan Luo2,3#,Qiang Gao4#,Jing Chen2,3#,Xiaolong Liu5,Liangqing Dong4,Yongjie Zhang6,Feng Shen7,Qingbao Cheng8,Chengjun Sui9,Jingfeng Liu5,Hongyang Wang2,3,Qiang Xia1,Lei Chen2,101Department of Liver Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,China;2International Cooperation Laboratory on Signal Transduction,Eastern Hepatobiliary Surgery Institute,Second Military Medical University,Shanghai,China;3National Center for Liver Cancer,Shanghai,China;4Department of Liver Surgery and Transplantation,Liver Cancer Institute,Zhongshan Hospital,and Key Laboratory of Carcinogenesis and Cancer Invasion(Ministry of Education),Fudan University,Shanghai,China;5Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou,China;6Biliary Tract Department II,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai,China;7Department of Hepatobiliary Surgery,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai,China;8Biliary Tract Department I,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai,China;9Department of Special Medical Care&Liver Transplantation,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai,China;10Shanghai Cancer Center,Shanghai Medical College,Fudan University;Shanghai,China Contributions:(I)Conception and design:S Jeong,G Luo,Q Gao,J Chen,J Liu,H Wang,Q Xia,L Chen;(II)Administrative support:All authors;(III)Provision of study materials or patients:S Jeong,G Luo,Q Gao,J Chen,J Liu,H Wang,Q Xia,L Chen;(IV)Collection and assembly of data:All authors;(V)Data analysis and interpretation:S Jeong,G Luo,Q Gao,J Chen,J Liu,H Wang,Q Xia,L Chen;(VI)Manuscript writing:All authors;(VII)Final approval of manuscript:All authors.#These authors contributed equally to this work.Correspondence to:Lei Chen;Hongyang Wang.International Cooperation Laboratory on Signal Transduction,Eastern Hepatobiliary Surgery Institute,Second Military Medical University,225 Changhai Road,Shanghai 200438,China.Email:chenlei@smmu.edu.cn;hywangk@vip.sina.com;Qiang Xia.Department of Liver Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,160 Pujian Road,Shanghai 200127,China.Email:xiaqiang@shsmu.edu.cn.