Researchers from China developed a practical prognostic nomogram to help clinicians assess patients with extrahepatic cholangiocarcinoma. They published their findings in Frontiers in Oncology

It is difficult but important to accurately estimate the prognosis of patients with extrahepatic cholangiocarcinoma.

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To overcome the limitations of the current TNM staging system such as exclusion of other factors like sex and age, low accuracy, and poor performance in predicting individual survival rates, the team of researchers led by Xiangpan Li, PhD, from the Department of Oncology, Renmin Hospital of Wuhan University in China constructed a novel practical nomogram and risk stratification system to predict cancer-specific survival in patients with extrahepatic cholangiocarcinoma.

The team selected 3415 patients who were diagnosed with extrahepatic cholangiocarcinoma between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) program database. They then divided the patients into 2 groups: the training group (n=1183) and the validation group (n=504). 

Statistical analyses identified 9 independent prognostic factors that the researchers used to establish the nomogram. These were age, marital status, American Joint Committee on Cancer (AJCC) stage, pathological grade of the cancer, regional lymph node status of the cancer, treatment status of the patient, whether the patient received chemotherapy, tumor size, and tumor number.

The nomogram showed satisfactory discrimination and was consistent with the actual observations. It also significantly outperformed the AJCC staging system and had better recognition than the AJCC staging system.

“Compared to the current AJCC staging system, our nomogram improves the ability to predict individual patient survival and shows consistent reliability and clinical utility in clinical evaluation,” the researchers concluded. “Further studies are needed to confirm our findings.”

Cholangiocarcinoma is a group of rare malignant tumors originating from cells of the biliary tree. Extrahepatic cholangiocarcinoma consists of perihilar and distal cholangiocarcinoma.


Zhao F, Yang D, He J, Ju X, Ding Y, Li X. Establishment and validation of a prognostic nomogram for extrahepatic cholangiocarcinoma. Front Oncol. Published online November 24, 2022. doi:10.3389/fonc.2022.1007538