Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma
ObjectivesTo establish a nomogram based on preoperative laboratory study variables using least absolute shrinkage and selection operator (LASSO) regression for differentiating combined hepatocellular cholangiocarcinoma (cHCC) from intrahepatic cholangiocarcinoma (iCCA).MethodsWe performed a retrospe...
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doaj-0080a44a7f334f4da759579fa70bcb9a2020-12-09T06:45:35ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-12-011010.3389/fonc.2020.598433598433Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic CholangiocarcinomaTao Wang0Wanxiang Wang1Jinfu Zhang2Xianwei Yang3Shu Shen4Wentao Wang5Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, ChinaDepartment of Hepatobiliary, Pancreatic, and Splenic Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, ChinaDepartment of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, ChinaDepartment of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, ChinaDepartment of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, ChinaDepartment of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, ChinaObjectivesTo establish a nomogram based on preoperative laboratory study variables using least absolute shrinkage and selection operator (LASSO) regression for differentiating combined hepatocellular cholangiocarcinoma (cHCC) from intrahepatic cholangiocarcinoma (iCCA).MethodsWe performed a retrospective analysis of iCCA and cHCC patients who underwent liver resection. Blood signatures were established using LASSO regression, and then, the clinical risk factors based on the multivariate logistic regression and blood signatures were combined to establish a nomogram for a differential preoperative diagnosis between iCCA and cHCC. The differential accuracy ability of the nomogram was determined by Harrell’s index (C-index) and decision curve analysis, and the results were validated using a validation set. Furthermore, patients were categorized into two groups according to the optimal cut-off values of the nomogram-based scores, and their survival differences were assessed using Kaplan-Meier curves.ResultsA total of 587 patients who underwent curative liver resection for iCCA or cHCC between January 2008 and December 2017 at West China Hospital were enrolled in this study. The cHCC score was based on the personalized levels of the seven laboratory study variables. On multivariate logistic analysis, the independent factors for distinguishing cHCC were age, sex, biliary duct stones, and portal hypertension, all of which were incorporated into the nomogram combined with the cHCC-score. The nomogram had a good discriminating capability, with a C-index of 0.796 (95% CI, 0.752–0.840). The calibration plot for distinguishing cHCC from iCCA showed optimal agreement between the nomogram prediction and actual observation in the training and validation sets. The decision curves indicated significant clinical usefulness.ConclusionThe nomogram showed good accuracy for the differential diagnosis between iCCA and cHCC preoperatively, and therapeutic decisions would improve if it was applied in clinical practice.https://www.frontiersin.org/articles/10.3389/fonc.2020.598433/fullintrahepatic cholangiocarcinomacombined hepatocellular cholangiocarcinomadifferential diagnosisleast absolute shrinkage and selection operator regressionnomogram |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tao Wang Wanxiang Wang Jinfu Zhang Xianwei Yang Shu Shen Wentao Wang |
spellingShingle |
Tao Wang Wanxiang Wang Jinfu Zhang Xianwei Yang Shu Shen Wentao Wang Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma Frontiers in Oncology intrahepatic cholangiocarcinoma combined hepatocellular cholangiocarcinoma differential diagnosis least absolute shrinkage and selection operator regression nomogram |
author_facet |
Tao Wang Wanxiang Wang Jinfu Zhang Xianwei Yang Shu Shen Wentao Wang |
author_sort |
Tao Wang |
title |
Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma |
title_short |
Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma |
title_full |
Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma |
title_fullStr |
Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma |
title_full_unstemmed |
Development and Validation of a Nomogram for Differentiating Combined Hepatocellular Cholangiocarcinoma From Intrahepatic Cholangiocarcinoma |
title_sort |
development and validation of a nomogram for differentiating combined hepatocellular cholangiocarcinoma from intrahepatic cholangiocarcinoma |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Oncology |
issn |
2234-943X |
publishDate |
2020-12-01 |
description |
ObjectivesTo establish a nomogram based on preoperative laboratory study variables using least absolute shrinkage and selection operator (LASSO) regression for differentiating combined hepatocellular cholangiocarcinoma (cHCC) from intrahepatic cholangiocarcinoma (iCCA).MethodsWe performed a retrospective analysis of iCCA and cHCC patients who underwent liver resection. Blood signatures were established using LASSO regression, and then, the clinical risk factors based on the multivariate logistic regression and blood signatures were combined to establish a nomogram for a differential preoperative diagnosis between iCCA and cHCC. The differential accuracy ability of the nomogram was determined by Harrell’s index (C-index) and decision curve analysis, and the results were validated using a validation set. Furthermore, patients were categorized into two groups according to the optimal cut-off values of the nomogram-based scores, and their survival differences were assessed using Kaplan-Meier curves.ResultsA total of 587 patients who underwent curative liver resection for iCCA or cHCC between January 2008 and December 2017 at West China Hospital were enrolled in this study. The cHCC score was based on the personalized levels of the seven laboratory study variables. On multivariate logistic analysis, the independent factors for distinguishing cHCC were age, sex, biliary duct stones, and portal hypertension, all of which were incorporated into the nomogram combined with the cHCC-score. The nomogram had a good discriminating capability, with a C-index of 0.796 (95% CI, 0.752–0.840). The calibration plot for distinguishing cHCC from iCCA showed optimal agreement between the nomogram prediction and actual observation in the training and validation sets. The decision curves indicated significant clinical usefulness.ConclusionThe nomogram showed good accuracy for the differential diagnosis between iCCA and cHCC preoperatively, and therapeutic decisions would improve if it was applied in clinical practice. |
topic |
intrahepatic cholangiocarcinoma combined hepatocellular cholangiocarcinoma differential diagnosis least absolute shrinkage and selection operator regression nomogram |
url |
https://www.frontiersin.org/articles/10.3389/fonc.2020.598433/full |
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