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A novel nomogram for the prediction of intrahepatic cholangiocarcinoma in patients with intrahepatic lithiasis complicated by imagiologically diagnosed mass

Authors Chen G, Yu H, Wang Y, Li C, Zhou M, Yu Z, Zheng X, Wu X, Shan Y, Zhang Q, Zeng Q

Received 19 November 2017

Accepted for publication 8 March 2018

Published 23 April 2018 Volume 2018:10 Pages 847—856


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Harikrishna Nakshatri

Gang Chen,1 Huajun Yu,1 Yi Wang,2 Chenhao Li,2 Mengtao Zhou,1 Zhengping Yu,1 Xiangwu Zheng,3 Xiuling Wu,4 Yunfeng Shan,1 Qiyu Zhang,1 Qiqiang Zeng1

1Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; 2Division of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China; 3Radiological Department, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; 4Department of Pathology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China

Accurate preoperative diagnosis of intrahepatic cholangiocarcinoma (ICC) among patients with imagiologically intrahepatic lithiasis (IHL) complicated by mass is crucial for timely and effective surgical intervention. The aim of the present study was to develop a nomogram to identify ICC associated with IHL (IHL-ICC).
Patients and methods: Data were obtained from a total of 252 consecutive patients with IHL complicated by mass. Multivariate logistic regression analysis was conducted to identify the clinicopathologic and imagiological characteristics that were potentially associated with ICC. A nomogram was developed based on the results of the multivariate analysis, and the value for prediction of ICC was assessed.
Results: The study revealed six potential predictors for IHL-ICC, including comprehensive imagiological diagnosis, biliary tract operation history, fever, ascites, cancer antigen (CA) 19-9, and carcinoembryonic antigen (CEA). The optimal cutoff value was 3.75 μg/L for serum CEA and 143.15 U/mL for serum CA 19-9. The accuracy of the nomogram in predicting ICC was 78.5%. The Youden index provided a value of 0.348, corresponding to a cutoff of 95 points, with an area under the curve of 0.863.
Conclusion: The nomogram holds promise as a novel and accurate tool in identifying IHL-ICC for hepatectomy, and in the differentiation of benign occupying lesions in IHL patients, resulting in the avoidance of unnecessary surgical resection.

Keywords: intrahepatic cholangiocarcinoma, intrahepatic lithiasis, benign occupying lesions, nomogram, CEA, CA 19-9

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