Performance of prognostic scores and staging systems in predicting long-term survival outcomes after surgery for intrahepatic cholangiocarcinoma

Stefan Buettner, Boris Galjart, Jeroen L.A. van Vugt, Fabio Bagante, Sorin Alexandrescu, Hugo P. Marques, Jorge Lamelas, Luca Aldrighetti, T. Clark Gamblin, Shishir K. Maithel, Carlo Pulitano, Georgios A. Margonis, Matthew Weiss, Todd W. Bauer, Feng Shen, George A. Poultsides, J. Wallis Marsh, Jan N.M. Ijzermans, Bas Groot Koerkamp, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Introduction: We sought to validate the commonly used prognostic models and staging systems for intrahepatic cholangiocarcinoma (ICC) in a large multi-center patient cohort. Methods: The overall (OS) and disease free survival (DFS) prognostic discriminatory ability of various commonly used models were assessed in a large retrospective cohort. Harrell's concordance index (c-index) was used to determine accuracy of model prediction. Results: Among 1054 ICC patients, median OS was 37.7 months and 1-, 3-, and 5-year survival, were 78.8%, 51.5%, and 39.3%, respectively. Recurrence of disease occurred in 454 (43.0%) patients with a median DFS of 29.6 months. One-, 3- and 5- year DFS were 64.6%, 46.5 % and 44.4%, respectively. The prognostic models associated with the best OS prediction were the Wang nomogram (c-index 0.668) and the Nathan staging system (c-index 0.639). No model was proficient in predicting DFS. Only the Wang nomogram exceeded a c-index of 0.6 for DFS (c-index 0.602). The c-index for the AJCC staging system was 0.637 for OS and 0.582 for DFS. Conclusions: While the Wang nomogram had the best discriminatory ability relative to OS and DFS, no ICC staging system or nomogram demonstrated excellent prognostic discrimination. The AJCC staging for ICC performed reasonably, although its overall discrimination was only modest-to-good.

Original languageEnglish (US)
Pages (from-to)1085-1095
Number of pages11
JournalJournal of Surgical Oncology
Issue number8
StatePublished - Dec 15 2017


  • intrahepatic cholangiocarcinoma
  • prognostic staging
  • recurrence
  • risk factors
  • survival

ASJC Scopus subject areas

  • Surgery
  • Oncology


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