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A Nomogram in Predicting Risks of Intrahepatic Cholangiocarcinoma After Partial Hepatectomy for Hepatolithiasis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Hepatolithiasis is associated with the development of intrahepatic cholangiocarcinoma (ICC). This study sought to investigate risk factors of ICC for hepatolithiasis after partial hepatectomy (PH) and to develop a model for predicting ICC risk.

Methods

Data on consecutive patients who underwent PH for hepatolithiasis at the Eastern Hepatobiliary Surgery Hospital between January 2009 and December 2011 were reviewed. Independent risk factors of ICC identified by Cox regression model were used to develop a nomogram in predicting ICC after PH for hepatolithiasis.

Results

Of 2056 patients, 168 developed ICC at a median follow-up of 7.2 years. The cumulative incidences of ICC at 3, 5, and 8 years after PH for hepatolithiasis were 3.0%, 6.5%, and 12.9%, respectively. Independent risk factors of ICC were identified to be a long duration of hepatolithiasis-related symptoms (hazard ratio, 1.088 [95% confidence interval, 1.057–1.120]), metabolic syndrome (2.036 [1.210–3.425]), a high neutrophil-to-lymphocyte ratio (1.250 [1.009–2.816] for 3–5 vs ≤3; 1.538 [1.048–2.069] for ≥5 vs ≤3), hepatic atrophy (1.711 [1.189–2.462]), segmental intensity differences (1.513 [1.052–2.176]), persistent biliary strictures (2.825 [1.480–5.391]), and residual stone disease (2.293 [1.511–3.481]). By incorporating these factors, a constructed nomogram showed a concordance index of 0.721 to predict ICC. The calibration plots demonstrated good agreement between observed and predicted morbidities. The optimal cutoff point for the nomogram was 48 in differentiating between high and low-risk of ICC.

Conclusions

A nomogram for predicting ICC after PH for hepatolithiasis was constructed based on risk factors of developing ICC. Patients with a nomogram point of ≥48 were predicted to have a high risk of ICC.

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Abbreviations

CHD:

Common hepatic duct

CBD:

Common bile duct

ICC:

Intrahepatic cholangiocarcinoma

PH:

Partial hepatectomy

CA19-9:

Carbohydrate antigen 19-9

CEA:

Carcinoembryonic antigen

MRI:

Magnetic resonance imaging

CT:

Computed tomography

MetS:

Metabolic syndrome

HBsAg:

Hepatitis B surface antigen

SIDs:

Segmental intensity differences

IQR:

Interquartile range

ROC:

Receiver operating characteristic

CI:

Confidence interval

NLR:

Neutrophil-to-lymphocyte ratio

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Funding

This study was supported by the State Key Project on Infectious Diseases of China (2018ZX10723204 to Dr. Shen), and the Shanghai Health Commission Scientific Research Fund (2018BR34 to Dr. Xia).

Author information

Author notes

  1. Hao Shen, Shichao Zhang and Yong Xia contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, No. 225, Changhai Road, Shanghai, 200438, China

    Hao Shen MD, Shichao Zhang MD, Yong Xia MD, Linhe Gan MD, Jun Li MD, Kui Wang MD, Wan Yee Lau MD, FRCS, Mengchao Wu MD & Feng Shen MD

  2. Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, the Union Hospital of Fujian Medical University, Fuzhou, China

    Can Chen MD

  3. Graduate School of Fujian Medical University, Fuzhou, China

    Can Chen MD, Linhe Gan MD & Mengchao Wu MD

  4. Department of Radiology, the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer, Second Military Medical University, Shanghai, China

    Lei Huo MD

  5. Department of Surgery, the Wexner Medical Center of Ohio State University, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD

  6. Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China

    Wan Yee Lau MD, FRCS

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  1. Hao Shen MD
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  2. Shichao Zhang MD
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  11. Mengchao Wu MD
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  12. Feng Shen MD
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Contributions

Concept and design: Feng Shen, Yong Xia, Jun Li, and Hao Shen.

Collection, analysis, and interpretation of data: Hao Shen, Shichao Zhang, Lei Huo, Kui Wang, and Linhe Gan.

Statistical analysis: Shichao Zhang, Can Chen, Jun Li, and Hao Shen.

Drafting of the manuscript: Hao Shen, Yong Xia, Can Chen, Kui Wang, Feng Shen, and Wan Yee Lau.

Critical revision of the manuscript for important intellectual content: Timothy M Pawlik, Wan Yee Lau, Feng Shen, and Mengchao Wu.

Obtained funding: Feng Shen and Yong Xia.

Study supervision: Feng Shen and Mengchao Wu.

Corresponding authors

Correspondence to Mengchao Wu MD or Feng Shen MD.

Ethics declarations

Ethics Approval and Consent to Participate

The study was conducted in compliance with the Declaration of Helsinki (1975) and its amendments and approved by the Institutional Ethics Committee of the EHBH. All patients provided informed consent for both the operation and for their data to be used for clinical research purposes.

Conflict of Interest

The authors declare no competing interests.

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Shen, H., Zhang, S., Xia, Y. et al. A Nomogram in Predicting Risks of Intrahepatic Cholangiocarcinoma After Partial Hepatectomy for Hepatolithiasis. J Gastrointest Surg 25, 2258–2267 (2021). https://doi.org/10.1007/s11605-021-04947-w

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  • DOI: https://doi.org/10.1007/s11605-021-04947-w

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