Cholangiocarcinoma Testing
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A group of researchers has developed a new model to estimate the risk of recurrence of intrahepatic cholangiocarcinoma (ICC) after resection.

“It could be applicative when estimating time-dependent disease status and stratifying individuals [whose] sole resection of the tumor would not be curative,” the authors explained in the study published in Hepatobiliary Surgery and Nutrition.

When comparing the proportion of recurrence-free survival and predicted risk rank of recurrence, the combined Cox & logistic ranking system (CCLRS) showed excellent accuracy and outperformed other predictive models for ICC. The area under the curve value was greater than 0.80 in the 3 validation cohorts assessed by the authors.

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The model was also excellent in predicting the specific time to recurrence after resection. It achieved a correlation index of 0.8204 with an error of ±0.5 years (P <.0001).

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Jeong et al compared the CCLRS with preexisting ICC staging systems. These included the American Joint Committee on Cancer (AJCC) eighth edition, AJCC seventh edition, Hyder nomogram, Liver Cancer Study Group of Japan (LCSGJ), and Japanese Society of Hepato-Biliary Pancreatic Surgery (JSHBPS). They observed a superior stage-dependent recurrence-free survival in the CCLRS compared to other systems (P <.0001).

To build the predictive model, the study authors used prognostic covariates associated with outcome in the analyses of the training cohort. These included diabetes, cholelithiasis, albumin, platelet count, alpha-fetoprotein, carbohydrate antigen 19-9, carcinoembryonic antigen, hepatitis B virus infection, tumor size and number, resection type, and lymph node metastasis.

The CCLRS stratifies ICC patients after resection into 7 ranks with different time-dependent risk probabilities. Jeong et al advised, “For patients with high ranks, intensive follow-up may be warranted. In addition, surgical treatment may not provide survival benefits in this group of patients.”


Jeong S, Luo G, Gao Q, et al. A combined Cox and logistic model provides accurate predictive performance in estimation of time-dependent probabilities for recurrence of intrahepatic cholangiocarcinoma after resection. Hepatobiliary Surg Nutr. 2021;10(4):464-475. doi:10.21037/hbsn.2020.01.07