BMC cancer · 2026
A prognostic model combining hilar lymph node metastasis and preoperative anemia to predict outcomes after curative resection of intrahepatic cholangiocarcinoma.
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Deng Min, He Benyi, Lin Zenghai, Zhang Deyao, Qiu Yuxiong, Li Dong, Tang Yajun, Guo Xianchao, Yuan Guojia, Qin Wei, Cai Hao, Qiu Yudong, Chen Zubing, Tang Di, Wei Wei, Guo Rongping
Аннотация
BACKGROUND: The role of hilar lymph node metastasis (LNM) in intrahepatic cholangiocarcinoma (ICC) was investigated and a simple postoperative risk-stratification system combining LNM and preoperative anemia was established to predict the outcome of patients with ICC after curative resection.
METHODS: A retrospective analysis was conducted on 384 patients who underwent hepatectomy for ICC. Both postoperative clinical outcomes and long-term oncological outcomes were systematically evaluated. Subsequently, predictive models were developed to assess the risks of tumor recurrence, overall survival (OS) and recurrence-free survival (RFS).
RESULTS: The primary cohort demonstrated 65.2% recurrence and 13.1-month median RFS (1-/3-/5-year rates: 51.9%/37.6%/25.0%), with median OS of 31.1 months (1-/3-/5-year rates: 81.8%/63.3%/54.1%). The external validation cohort showed 79.4% recurrence, 11.7-month median RFS (1-/3-/5-year rates: 49.5%/11.8%/5.9%), and 16.2-month median OS (1-/3-/5-year rates: 98.1%/10.4%/6.4%). We developed nomograms for recurrence, OS, and RFS incorporating LNM and preoperative anemia, yielding C-indices of 0.881, 0.802, and 0.758, respectively. Risk-stratified analysis revealed significant prognostic discrimination: high-risk patients demonstrated substantially inferior 5-year OS compared to low-risk patients (19.6% vs. 86.6%, P < 0.001), with median OS of 16.7 months versus not reached. Similarly, median RFS declined from not reached in low-risk patients to 6.1 months in high-risk patients. These results were confirmed in the external validation cohort, where high-risk status corresponded to a median OS of 14.4 months and median RFS of 8.1 months (both P < 0.001).
CONCLUSIONS: The integration of LNM status and preoperative anemia emerges as a novel and clinically valuable prognostic indicator, effectively predicting outcomes in patients with ICC following curative resection, thereby providing tailored clinical guidance for postoperative adjuvant therapy selection and intensive surveillance planning.
METHODS: A retrospective analysis was conducted on 384 patients who underwent hepatectomy for ICC. Both postoperative clinical outcomes and long-term oncological outcomes were systematically evaluated. Subsequently, predictive models were developed to assess the risks of tumor recurrence, overall survival (OS) and recurrence-free survival (RFS).
RESULTS: The primary cohort demonstrated 65.2% recurrence and 13.1-month median RFS (1-/3-/5-year rates: 51.9%/37.6%/25.0%), with median OS of 31.1 months (1-/3-/5-year rates: 81.8%/63.3%/54.1%). The external validation cohort showed 79.4% recurrence, 11.7-month median RFS (1-/3-/5-year rates: 49.5%/11.8%/5.9%), and 16.2-month median OS (1-/3-/5-year rates: 98.1%/10.4%/6.4%). We developed nomograms for recurrence, OS, and RFS incorporating LNM and preoperative anemia, yielding C-indices of 0.881, 0.802, and 0.758, respectively. Risk-stratified analysis revealed significant prognostic discrimination: high-risk patients demonstrated substantially inferior 5-year OS compared to low-risk patients (19.6% vs. 86.6%, P < 0.001), with median OS of 16.7 months versus not reached. Similarly, median RFS declined from not reached in low-risk patients to 6.1 months in high-risk patients. These results were confirmed in the external validation cohort, where high-risk status corresponded to a median OS of 14.4 months and median RFS of 8.1 months (both P < 0.001).
CONCLUSIONS: The integration of LNM status and preoperative anemia emerges as a novel and clinically valuable prognostic indicator, effectively predicting outcomes in patients with ICC following curative resection, thereby providing tailored clinical guidance for postoperative adjuvant therapy selection and intensive surveillance planning.