[Research on postoperative survival prediction model of intrahepatic cholangiocarcinoma guided by lymph node metastasis rate].

Objective

To analyze the predictive model of lymph node metastasis rate (LNR) in patients with intrahepatic cholangiocarcinoma and its relationship with prognosis.

Methods

This study included clinical characteristics and prognostic information of 172 patients with intrahepatic cholangiocarcinoma. Receiver operating characteristic (ROC) curves were used to calculate the optimal cutoff values for groups. Kaplan Meier survival curves were plotted using R language, and critical factors affecting prognosis were determined by Cox regression analysis. A prognostic prediction model was constructed and visualized using nomogram, and this model was validated using the SEER database.

Results

Through ROC curve analysis, with 3-year overall survival (OS) as the benchmark, an LNR of 0.15 was identified as the optimal cutoff value for predicting the prognosis of intrahepatic cholangiocarcinoma patients, with an area under the curve of 0.764 (95% CI: 0.690, 0.838). Patients were divided into a low LNR group (LNR＜0.15, n=97) and a high LNR group (LNR≥0.15, n=75) based on the LNR value. Statistically significant differences were observed between the two groups in terms of carbohydrate antigen 19-9, tumor size, lymph node metastasis, tumor number, and stage (all P＜0.05). The median survival time of the high LNR group was 20 months (95% CI: 13-23), significantly shorter than that of the low LNR group, which was 36 months (95% CI: 21-43) (P＜0.001). Multivariate analysis revealed that a high LNR value (HR=0.55, 95% CI: 0.32-0.95, P=0.033), age＞60 years (HR=0.53, 95% CI: 0.35-0.81, P=0.004), and tumor diameter＞5.5 cm (HR=0.62, 95% CI: 0.41-0.93, P=0.022) were independent factors affecting OS. A prognostic prediction model was established based on these independent factors, and the predicted 1-year, 2-year, and 3-year survival rates were close to the actual observed values. Validation using the SEER database also demonstrated the high predictive accuracy of this model.

Conclusion

The clinical prognostic model based on lymph node metastasis rate can effectively predict the postoperative survival of patients with intrahepatic cholangiocarcinoma and provide important basis for clinical decision.