Prognostic system for cholangiocarcinoma.

Introduction:Perihilar cholangiocarcinoma (PCC) is primary biliary malignancy increasing worldwide and its classification and management is evolving progressively. Perihilar cholangiocarcinoma has poor prognosis however surgical resection can prolong survival. Prognostic classification and scoring systems are available but there is not general agreement about their prognostic significance. Aim of this study was to create an effective prognostic nomogram for patients submitted to surgical resection for perihilar cholangiocarcinoma. Material and Methods: Creation of nomogram was based on consecutive series of 69 patients submitted to surgical resection for perihilar cholangiocarcinoma between 1990 and 2012. Clinical and pathological variables were evaluated. Prognostic model for risk to die within 3 years after surgical resection was created according to variables selected at multivariate analysis. Nomogram was created by prognostic model. Internal validation of nomogram was performed. Predictive accuracy and discriminative capability of our prognostic model was compared with other four prognostic systems for PCC. Results: Independent significant prognostic factor for survival at multivariate analysis were increased CA 19.9, number of lymph node harvested, number of positive lymph node, caudate lobe resection and portal vein resection; all these variables were selected for prognostic model. Three group of patients according to low (<50%), medium (50-75%) or high (>75%) risk to die within 3 year were identified by nomogram. Calibration curve for probability of survival showed good agreement between prediction of nomogram and actual observation. Our prognostic model resulted more accurate in predict survival compared to AJCC/UICC TNM staging system, MSKCC classification, JSBS staging system and Kaiser prognostic scoring system (AIC 268.9). Conclusion: Our prognostic nomogram resulted to be more accurate in predict survival for patients with perihilar cholangiocarcinoma submitted to surgical resection than previous staging system.