Table_1_A Novel Nomogram Based on Hepatic and Coagulation Function for Evaluating Outcomes of Intrahepatic Cholangiocarcinoma After Curative Hepatectomy: A Multi-Center Study of 653 Patients.docx

Background and AimsHepatic and coagulation function are routine laboratory tests prior to curative hepatectomy. The prognostic value of gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR) and international normalized ratio (INR) in surgically treated patients with intrahepatic cholangiocarcinoma (ICC) remains unclear.MethodsICC patients received curative hepatectomy in two west China centers were included. Time-dependent ROC curves were conducted to compare established indexes with prognostic value for ICC. GPR-INR score was introduced and evaluated using the Time-dependent AUC curve and Kaplan-Meier survival analysis. A novel nomogram based on the GPR-INR score was proposed; Harrell’s C-index, calibration curve and decision curve analysis were used to assess this nomogram.ResultsA total of 653 patients were included. The areas under ROC curves of GPR and INR in OS and RFS were superior to other indexes. Patients with a high GPR-INR score (1,2) presented significantly decreased overall survival (OS) and recurrence-free survival (RFS); GPR-INR sore, along with several clinicopathological indexes were selected into the nomogram, the calibration curve for OS probability showed good coincidence between the nomogram and the actual surveillance. The C-index of the nomogram was 0.708 (derivation set) and 0.746 (validation set), which was more representative than the C-indexes of the GPR-INR score (0.597, 0.678). In decision curve analysis, the net benefits of the nomogram in derivation and validation set were higher than Barcelona Clinic Liver Cancer staging (BCLC) classification and American Joint Committee on Cancer (AJCC) TNM 8th staging system.ConclusionsThe proposed nomogram generated superior discriminative ability to established staging systems; it is profitable to applicate this nomogram in clinical practice.

背景与目的：肝脏功能和凝血功能是肝脏切除术前的常规实验室检查。在手术治疗的肝内胆管癌（ICC）患者中，γ-谷氨酰转肽酶（GGT）与血小板比值（GPR）以及国际标准化比率（INR）的预后价值尚不明确。方法：纳入了两个西部中国中心接受治愈性肝切除术的ICC患者。通过时间依赖性ROC曲线对具有预后价值的ICC的已建立指标进行了比较。引入并使用时间依赖性AUC曲线和Kaplan-Meier生存分析评估了GPR-INR评分。提出了基于GPR-INR评分的新型评分图；采用Harrell的C指数、校准曲线和决策曲线分析评估该评分图。结果：共纳入了653名患者。GPR和INR在总生存期（OS）和无病生存期（RFS）的ROC曲线下面积优于其他指标。高GPR-INR评分（1,2）的患者显示出显著降低的总生存期（OS）和无病生存期（RFS）；GPR-INR评分，连同几个临床病理指标一起被选入评分图，OS概率的校准曲线显示评分图与实际监测的良好一致性。评分图的C指数为0.708（推导集）和0.746（验证集），比GPR-INR评分的C指数（0.597，0.678）更具代表性。在决策曲线分析中，推导集和验证集中评分图的净收益高于巴塞罗那肝脏癌临床分期（BCLC）分类和美国癌症联合委员会（AJCC）第8版TNM分期系统。结论：提出的评分图在区分能力上优于已建立的分期系统；将此评分图应用于临床实践具有经济效益。