Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches

Detalhes bibliográficos
Autor(a) principal: Tsilimigras, D
Data de Publicação: 2020
Outros Autores: Sahara, K, Wu, L, Moris, D, Bagante, F, Guglielmi, A, Aldrighetti, L, Weiss, M, Bauer, T, Alexandrescu, S, Poultsides, G, Maithel, S, Pinto Marques, H, Martel, G, Pulitano, C, Shen, F, Soubrane, O, Koerkamp, B, Moro, A, Sasaki, K, Aucejo, F, Zhang, XF, Matsuyama, R, Endo, I, Pawlik, T
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.17/3771
Resumo: Importance: Although surgery offers the best chance of a potential cure for patients with localized, resectable intrahepatic cholangiocarcinoma (ICC), prognosis of patients remains dismal largely because of a high incidence of recurrence. Objective: To predict very early recurrence (VER) (ie, recurrence within 6 months after surgery) following resection for ICC in the pre- and postoperative setting. Design, setting, and participants: Patients who underwent curative-intent resection for ICC between May 1990 and July 2016 were identified from an international multi-institutional database. The study was conducted at The Ohio State University in collaboration with all other participating institutions. The data were analyzed in December 2019. Main outcomes and measures: Two logistic regression models were constructed to predict VER based on pre- and postoperative variables. The final models were used to develop an online calculator to predict VER and the tool was internally and externally validated. Results: Among 880 patients (median age, 59 years [interquartile range, 51-68 years]; 388 women [44.1%]; 428 [50.2%] white; 377 [44.3%] Asian; 27 [3.2%] black]), 196 (22.3%) developed VER. The 5-year overall survival among patients with and without VER was 8.9% vs 49.8%, respectively (P < .001). A preoperative model was able to stratify patients relative to the risk for VER: low risk (6-month recurrence-free survival [RFS], 87.7%), intermediate risk (6-month RFS, 72.3%), and high risk (6-month RFS, 49.5%) (log-rank P < .001). The postoperative model similarly identified discrete cohorts of patients based on probability for VER: low risk (6-month RFS, 90.0%), intermediate risk (6-month RFS, 73.1%), and high risk (6-month RFS, 48.5%) (log-rank, P < .001). The calibration and predictive accuracy of the pre- and postoperative models were good in the training (C index: preoperative, 0.710; postoperative, 0.722) as well as the internal (C index: preoperative, 0.715; postoperative, 0.728; bootstrapping resamples, n = 5000) and external (C index: postoperative, 0.672) validation data sets. Conclusion and relevance: An easy-to-use online calculator was developed to help clinicians predict the chance of VER after curative-intent resection for ICC. The tool performed well on internal and external validation. This tool may help clinicians in the preoperative selection of patients for neoadjuvant therapy as well as during the postoperative period to inform surveillance strategies.
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spelling Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment ApproachesAgedBile Duct NeoplasmsCholangiocarcinomaCohort StudiesDisease-Free SurvivalFemaleHumansLogistic ModelsMaleMiddle AgedNeoadjuvant TherapyNeoplasm Recurrence, LocalPredictive Value of TestsRisk AssessmentSurvival RateHepatectomyHCC CIRImportance: Although surgery offers the best chance of a potential cure for patients with localized, resectable intrahepatic cholangiocarcinoma (ICC), prognosis of patients remains dismal largely because of a high incidence of recurrence. Objective: To predict very early recurrence (VER) (ie, recurrence within 6 months after surgery) following resection for ICC in the pre- and postoperative setting. Design, setting, and participants: Patients who underwent curative-intent resection for ICC between May 1990 and July 2016 were identified from an international multi-institutional database. The study was conducted at The Ohio State University in collaboration with all other participating institutions. The data were analyzed in December 2019. Main outcomes and measures: Two logistic regression models were constructed to predict VER based on pre- and postoperative variables. The final models were used to develop an online calculator to predict VER and the tool was internally and externally validated. Results: Among 880 patients (median age, 59 years [interquartile range, 51-68 years]; 388 women [44.1%]; 428 [50.2%] white; 377 [44.3%] Asian; 27 [3.2%] black]), 196 (22.3%) developed VER. The 5-year overall survival among patients with and without VER was 8.9% vs 49.8%, respectively (P < .001). A preoperative model was able to stratify patients relative to the risk for VER: low risk (6-month recurrence-free survival [RFS], 87.7%), intermediate risk (6-month RFS, 72.3%), and high risk (6-month RFS, 49.5%) (log-rank P < .001). The postoperative model similarly identified discrete cohorts of patients based on probability for VER: low risk (6-month RFS, 90.0%), intermediate risk (6-month RFS, 73.1%), and high risk (6-month RFS, 48.5%) (log-rank, P < .001). The calibration and predictive accuracy of the pre- and postoperative models were good in the training (C index: preoperative, 0.710; postoperative, 0.722) as well as the internal (C index: preoperative, 0.715; postoperative, 0.728; bootstrapping resamples, n = 5000) and external (C index: postoperative, 0.672) validation data sets. Conclusion and relevance: An easy-to-use online calculator was developed to help clinicians predict the chance of VER after curative-intent resection for ICC. The tool performed well on internal and external validation. This tool may help clinicians in the preoperative selection of patients for neoadjuvant therapy as well as during the postoperative period to inform surveillance strategies.American Medical AssociationRepositório do Centro Hospitalar Universitário de Lisboa Central, EPETsilimigras, DSahara, KWu, LMoris, DBagante, FGuglielmi, AAldrighetti, LWeiss, MBauer, TAlexandrescu, SPoultsides, GMaithel, SPinto Marques, HMartel, GPulitano, CShen, FSoubrane, OKoerkamp, BMoro, ASasaki, KAucejo, FZhang, XFMatsuyama, REndo, IPawlik, T2021-07-15T15:50:01Z20202020-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3771engJAMA Surg. 2020 Sep 1;155(9):823-831.10.1001/jamasurg.2020.1973info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:44:15Zoai:repositorio.chlc.min-saude.pt:10400.17/3771Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:21:05.591209Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
title Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
spellingShingle Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
Tsilimigras, D
Aged
Bile Duct Neoplasms
Cholangiocarcinoma
Cohort Studies
Disease-Free Survival
Female
Humans
Logistic Models
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Predictive Value of Tests
Risk Assessment
Survival Rate
Hepatectomy
HCC CIR
title_short Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
title_full Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
title_fullStr Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
title_full_unstemmed Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
title_sort Very Early Recurrence After Liver Resection for Intrahepatic Cholangiocarcinoma: Considering Alternative Treatment Approaches
author Tsilimigras, D
author_facet Tsilimigras, D
Sahara, K
Wu, L
Moris, D
Bagante, F
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, T
Alexandrescu, S
Poultsides, G
Maithel, S
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, B
Moro, A
Sasaki, K
Aucejo, F
Zhang, XF
Matsuyama, R
Endo, I
Pawlik, T
author_role author
author2 Sahara, K
Wu, L
Moris, D
Bagante, F
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, T
Alexandrescu, S
Poultsides, G
Maithel, S
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, B
Moro, A
Sasaki, K
Aucejo, F
Zhang, XF
Matsuyama, R
Endo, I
Pawlik, T
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Tsilimigras, D
Sahara, K
Wu, L
Moris, D
Bagante, F
Guglielmi, A
Aldrighetti, L
Weiss, M
Bauer, T
Alexandrescu, S
Poultsides, G
Maithel, S
Pinto Marques, H
Martel, G
Pulitano, C
Shen, F
Soubrane, O
Koerkamp, B
Moro, A
Sasaki, K
Aucejo, F
Zhang, XF
Matsuyama, R
Endo, I
Pawlik, T
dc.subject.por.fl_str_mv Aged
Bile Duct Neoplasms
Cholangiocarcinoma
Cohort Studies
Disease-Free Survival
Female
Humans
Logistic Models
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Predictive Value of Tests
Risk Assessment
Survival Rate
Hepatectomy
HCC CIR
topic Aged
Bile Duct Neoplasms
Cholangiocarcinoma
Cohort Studies
Disease-Free Survival
Female
Humans
Logistic Models
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Predictive Value of Tests
Risk Assessment
Survival Rate
Hepatectomy
HCC CIR
description Importance: Although surgery offers the best chance of a potential cure for patients with localized, resectable intrahepatic cholangiocarcinoma (ICC), prognosis of patients remains dismal largely because of a high incidence of recurrence. Objective: To predict very early recurrence (VER) (ie, recurrence within 6 months after surgery) following resection for ICC in the pre- and postoperative setting. Design, setting, and participants: Patients who underwent curative-intent resection for ICC between May 1990 and July 2016 were identified from an international multi-institutional database. The study was conducted at The Ohio State University in collaboration with all other participating institutions. The data were analyzed in December 2019. Main outcomes and measures: Two logistic regression models were constructed to predict VER based on pre- and postoperative variables. The final models were used to develop an online calculator to predict VER and the tool was internally and externally validated. Results: Among 880 patients (median age, 59 years [interquartile range, 51-68 years]; 388 women [44.1%]; 428 [50.2%] white; 377 [44.3%] Asian; 27 [3.2%] black]), 196 (22.3%) developed VER. The 5-year overall survival among patients with and without VER was 8.9% vs 49.8%, respectively (P < .001). A preoperative model was able to stratify patients relative to the risk for VER: low risk (6-month recurrence-free survival [RFS], 87.7%), intermediate risk (6-month RFS, 72.3%), and high risk (6-month RFS, 49.5%) (log-rank P < .001). The postoperative model similarly identified discrete cohorts of patients based on probability for VER: low risk (6-month RFS, 90.0%), intermediate risk (6-month RFS, 73.1%), and high risk (6-month RFS, 48.5%) (log-rank, P < .001). The calibration and predictive accuracy of the pre- and postoperative models were good in the training (C index: preoperative, 0.710; postoperative, 0.722) as well as the internal (C index: preoperative, 0.715; postoperative, 0.728; bootstrapping resamples, n = 5000) and external (C index: postoperative, 0.672) validation data sets. Conclusion and relevance: An easy-to-use online calculator was developed to help clinicians predict the chance of VER after curative-intent resection for ICC. The tool performed well on internal and external validation. This tool may help clinicians in the preoperative selection of patients for neoadjuvant therapy as well as during the postoperative period to inform surveillance strategies.
publishDate 2020
dc.date.none.fl_str_mv 2020
2020-01-01T00:00:00Z
2021-07-15T15:50:01Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/3771
url http://hdl.handle.net/10400.17/3771
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv JAMA Surg. 2020 Sep 1;155(9):823-831.
10.1001/jamasurg.2020.1973
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv American Medical Association
publisher.none.fl_str_mv American Medical Association
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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