TY - JOUR
T1 - Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma
T2 - does the predicted survival justify the surgical risk?
AU - van Keulen, Anne-Marleen
AU - Buettner, Stefan
AU - Erdmann, Joris I.
AU - Pratschke, Johann
AU - Ratti, Francesca
AU - Jarnagin, William R.
AU - Schnitzbauer, Andreas A.
AU - Lang, Hauke
AU - Ruzzenente, Andrea
AU - Nadalin, Silvio
AU - Cescon, Matteo
AU - Topal, Baki
AU - Olthof, Pim B.
AU - Groot Koerkamp, Bas
N1 - Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - BACKGROUND: The risk of death after surgery for perihilar cholangiocarcinoma is high; nearly one in every five patients dies within 90 days after surgery. When the oncological benefit is limited, a high-risk resection may not be justified. This retrospective cohort study aimed to create two preoperative prognostic models to predict 90-day mortality and overall survival (OS) after major liver resection for perihilar cholangiocarcinoma. METHODS: Separate models were built with factors known before surgery using multivariable regression analysis for 90-day mortality and OS. Patients were categorized in three groups: favourable profile for surgical resection (90-day mortality rate below 10 per cent and predicted OS more than 3 years), unfavourable profile (90-day mortality rate above 25 per cent and/or predicted OS below 1.5 years), and an intermediate group. RESULTS: A total of 1673 patients were included. Independent risk factors for both 90-day mortality and OS included ASA grade III-IV, large tumour diameter, and right-sided hepatectomy. Additional risk factors for 90-day mortality were advanced age and preoperative cholangitis; those for long-term OS were high BMI, preoperative jaundice, Bismuth IV, and hepatic artery involvement. In total, 294 patients (17.6 per cent) had a favourable risk profile for surgery (90-day mortality rate 5.8 per cent and median OS 42 months), 271 patients (16.2 per cent) an unfavourable risk profile (90-day mortality rate 26.8 per cent and median OS 16 months), and 1108 patients (66.2 per cent) an intermediate risk profile (90-day mortality rate 12.5 per cent and median OS 27 months). CONCLUSION: Preoperative risk models for 90-day mortality and OS can help identify patients with resectable perihilar cholangiocarcinoma who are unlikely to benefit from surgical resection. Tailored shared decision-making is particularly essential for the large intermediate group.
AB - BACKGROUND: The risk of death after surgery for perihilar cholangiocarcinoma is high; nearly one in every five patients dies within 90 days after surgery. When the oncological benefit is limited, a high-risk resection may not be justified. This retrospective cohort study aimed to create two preoperative prognostic models to predict 90-day mortality and overall survival (OS) after major liver resection for perihilar cholangiocarcinoma. METHODS: Separate models were built with factors known before surgery using multivariable regression analysis for 90-day mortality and OS. Patients were categorized in three groups: favourable profile for surgical resection (90-day mortality rate below 10 per cent and predicted OS more than 3 years), unfavourable profile (90-day mortality rate above 25 per cent and/or predicted OS below 1.5 years), and an intermediate group. RESULTS: A total of 1673 patients were included. Independent risk factors for both 90-day mortality and OS included ASA grade III-IV, large tumour diameter, and right-sided hepatectomy. Additional risk factors for 90-day mortality were advanced age and preoperative cholangitis; those for long-term OS were high BMI, preoperative jaundice, Bismuth IV, and hepatic artery involvement. In total, 294 patients (17.6 per cent) had a favourable risk profile for surgery (90-day mortality rate 5.8 per cent and median OS 42 months), 271 patients (16.2 per cent) an unfavourable risk profile (90-day mortality rate 26.8 per cent and median OS 16 months), and 1108 patients (66.2 per cent) an intermediate risk profile (90-day mortality rate 12.5 per cent and median OS 27 months). CONCLUSION: Preoperative risk models for 90-day mortality and OS can help identify patients with resectable perihilar cholangiocarcinoma who are unlikely to benefit from surgical resection. Tailored shared decision-making is particularly essential for the large intermediate group.
UR - http://www.scopus.com/inward/record.url?scp=85152244850&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85152244850&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36918735
U2 - https://doi.org/10.1093/bjs/znad057
DO - https://doi.org/10.1093/bjs/znad057
M3 - Article
C2 - 36918735
SN - 0007-1323
VL - 110
SP - 599
EP - 605
JO - The British journal of surgery
JF - The British journal of surgery
IS - 5
ER -