Premium
Discordance in prediction of prognosis among patients with intrahepatic cholangiocarcinoma: A preoperative vs postoperative perspective
Author(s) -
Moro Amika,
Paredes Anghela Z.,
Farooq Ayesha,
Sahara Kota,
Tsilimigras Diamantis I.,
Mehta Rittal,
Endo Itaru,
Guglielmi Alfredo,
Aldrighetti Luca,
Alexandrescu Sorin,
Marques Hugo P.,
Shen Feng,
Koerkamp Bas G.,
Sasaki Kazunari,
Pawlik Timothy M.
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25671
Subject(s) - medicine , odds ratio , confidence interval , logistic regression , hepatectomy , intrahepatic cholangiocarcinoma , surgery , resection
Background The objective of the current study was to characterize patients with intrahepatic cholangiocarcinoma (ICC) undergoing curative‐intent surgery with discordant preoperative and postoperative prediction scores and determine factors associated with prediction discrepancy. Methods Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified in a multi‐institutional international database. Preoperative and postoperative prognostic models were designed and discordant prognostic scores were identified. A multivariable logistic regression analysis was completed to determined factors associated with score discordance. Results Among 1149 patients, those who had concordant prediction scores were older (median age, 60 vs 56), and more likely to have a smaller median tumor size (6.0 vs 7.5 cm) (all P < .05). On multivariable logistic analysis, patients with higher neutrophil‐lymphocyte ratio (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09‐1.19), higher CEA levels (OR, 1.25; 95% CI, 1.04‐1.50), larger tumors (OR, 1.10; 95% CI, 1.04‐1.15) and suspicious lymph nodes (OR, 2.05; 95% CI, 1.25‐3.36) were more likely to have preoperative and postoperative score discordance. Older patients had decreased odds of having score discordance (OR, 0.98; 95% CI, 0.96‐0.99). Patients with score discordance had worse overall survival compared with patients with concordant scores (median:15.9 vs 21.7 months, P < .05). Conclusion Score discordance may reflect an aggressive variant of ICC that would benefit from early integration of multidisciplinary treatment strategies.