Novel Preoperative Nomogram for Prediction of Futile Resection in Patients Undergoing Exploration for Potentially Resectable Intrahepatic Cholangiocarcinoma

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Abstract

Surgical resection is the treatment of choice for intrahepatic cholangiocarcinoma (IHCC). However, discrepancies between preoperative workup and intraoperative findings can occur, resulting in unexpected and unfavorable surgical outcomes. The aim of this study was to develop a feasible preoperative nomogram to predict futile resection of IHCC. A total of 718 patients who underwent curative-intent surgery for IHCC between January 2005 and December 2014 were included. The patients were divided into a training cohort (2005-2010, n = 377) and validation cohort (2011-2014, n = 341). The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curves. In multivariate analysis of the training cohort, tumor number, lymph node enlargement, presence of intrahepatic duct stones, and elevated neutrophil-to-lymphocyte ratio (NLR) (≥2.7) were independently correlated with the risk of futile resection. The predictive nomogram was established based on these factors. The concordance index of the nomogram for the training and the validation cohorts was 0.847 and 0.740, respectively. In this nomogram, the negative predictive value (128 points, probability of futile resection of 36%) in the validation cohort was 93.3%. In conclusion, our novel preoperatively applicable nomogram is a feasible method to predict futile resection of IHCC in curative-intent surgery.

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