Preoperative Risk Score to Predict Occult Metastatic or Locally Advanced Disease in Patients with Resectable Perihilar Cholangiocarcinoma on Imaging.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Many patients with resectable perihilar cholangiocarcinoma (PHC) on imaging are diagnosed intraoperatively with occult metastatic or locally advanced disease, precluding a curative-intent resection. This study aimed to develop and validate a preoperative risk score. STUDY DESIGN: Patients with resectable PHC on imaging who underwent operations in 2 high-volume centers (US and Europe) between 2000 and 2015 were included. Multivariable logistic regression analysis was used to develop the risk score. Cross-validation was used to validate the score, alternating the 2 centers as "training" and "testing" datasets. RESULTS: Of 566 patients who underwent operations, 309 (55%) patients had a resection, and in 257 (45%) patients, a curative-intent resection was precluded due to distant metastasis (n = 151 [27%]) or locally advanced disease (n = 106 [19%]). Preoperative predictors included bilirubin >2 mg/dL, bile duct involvement on imaging, portal vein involvement on imaging (≥180 degrees), hepatic artery involvement on imaging (≥180 degrees), and suspicious lymph nodes on imaging. The new risk score (c-index 0.75 after cross-validation) provided significantly more accurate predictions than the Bismuth classification (c-index 0.62), Blumgart T-staging (c-index 0.67), and cTNM staging (c-index 0.68). The new risk score identified 4 risk groups for occult metastatic or locally advanced disease: low (14.7%), intermediate (29.5%), high (47.3%), and very high risk (81.3%). The preoperative score groups also predicted survival after operation, irrespective of intraoperative findings (p < 0.001). CONCLUSIONS: The validated risk score can predict occult distant metastatic or locally advanced PHC based on 5 preoperatively available factors. The score can be useful in preoperative shared decision making and selection of patients in neoadjuvant clinical trials.

Full Text

Duke Authors

Cited Authors

  • Wiggers, JK; Groot Koerkamp, B; van Klaveren, D; Coelen, RJ; Nio, CY; Allen, PJ; Besselink, MG; Busch, OR; D'Angelica, MI; DeMatteo, RP; Kingham, TP; van Gulik, TM; Jarnagin, WR

Published Date

  • August 2018

Published In

Volume / Issue

  • 227 / 2

Start / End Page

  • 238 - 246.e2

PubMed ID

  • 29627334

Pubmed Central ID

  • PMC6089225

Electronic International Standard Serial Number (EISSN)

  • 1879-1190

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2018.03.041


  • eng

Conference Location

  • United States