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Preoperative MRI features predicting very early recurrence of intrahepatic mass-forming cholangiocarcinoma after R0 resection: a comparison with the AJCC 8th edition staging system

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to establish a nomogram based on preoperative magnetic resonance imaging (MRI) features to predict the very early recurrence (VER, less than 6 months) of intrahepatic mass-forming cholangiocarcinoma (IMCC) after R0 resection.

Methods

This study enrolled a group of 193 IMCC patients from our institution between March 2010 and January 2022. Patients were allocated into the development cohort (n = 137) and the validation cohort (n = 56), randomly, and the preoperative clinical and MRI features were collected. Univariate and multivariate stepwise logistic regression assessments were adopted to assess predictors of VER. Nomogram was constructed and certificated in the validation cohort. The performance of the prediction nomogram was evaluated by its discrimination, calibration, and clinical utility. The performance of the nomogram was compared with the T stage of the American Joint Committee on Cancer (AJCC) 8th edition staging system.

Results

Fifty-three patients (27.5%) experienced VER of the tumor and 140 patients (72.5%) with non-VER, during the follow-up period. After multivariate stepwise logistic regression, number of lesions, diffuse hypoenhancement on arterial phase, necorsis and suspicious lymph nodes were independently associated with VER. The nomogram demonstrated significantly higher area under the curve (AUC) of 0.813 than T stage (AUC = 0.666, P = 0.006) in the development cohort, whereas in the validation cohort, the nomogram showed better discrimination performance, with an AUC of 0.808 than T stage (0.705) with no significantly difference (P = 0.230). Decision curve analysis reflected the clinical net benefit of the nomogram.

Conclusion

The nomogram based on preoperative MRI features is a reliable tool to predict VER for patients with IMCC after R0 resection. This nomogram will be helpful to improve survival prediction and individualized treatment.

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Abbreviations

AFP:

Alpha-fetoprotein

AJCC:

American Joint Committee on Cancer

AP:

Arterial phase

AUC:

Area under the curve

CA 19-9:

Cancer antigen 19-9

CEA:

Carcinoembryonic antigen

CI:

Confidence interval

IMCC:

Intrahepatic mass-forming cholangiocarcinoma

NT:

Neoadjuvant therapy

OR:

Odds ratio

ROC:

Receiver operating characteristic

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Funding

No funding was received for conducting this study.

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Author notes

  1. Shuangmei Zou and Hongmei Zhang have contributed equally to this article.

Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Shuang Chen, Lijuan Wan, Rui Zhao, Wenjing Peng & Hongmei Zhang

  2. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Shuangmei Zou

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Contributions

Study concepts/study design: SC, HZ; data acquisition or data analysis/interpretation: LW, RZ, WP; statistical analysis: SC, LW, RZ; drafting the article or revising it critically for important intellectual content: SC, SZ, HZ; final approval of the version to be submitted: SC, LW, RZ, WP, SZ, HZ authors.

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Correspondence to Hongmei Zhang.

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This study was approved by the institutional review board in view of the retrospective nature of the study.

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Chen, S., Wan, L., Zhao, R. et al. Preoperative MRI features predicting very early recurrence of intrahepatic mass-forming cholangiocarcinoma after R0 resection: a comparison with the AJCC 8th edition staging system. Abdom Radiol 49, 21–33 (2024). https://doi.org/10.1007/s00261-023-04038-1

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