Preoperative risk score to predict occult metastatic or locally advanced disease in patients with resectable perihilar cholangiocarcinoma on Imaging Journal Article


Authors: Wiggers, J. K.; Groot Koerkamp, B.; van Klaveren, D.; Coelen, R. J.; Nio, C. Y.; Allen, P. J.; Besselink, M. G.; Busch, O. R.; D'Angelica, M. I.; DeMatteo, R. P.; Kingham, T. P.; van Gulik, T. M.; Jarnagin, W. R.
Article Title: Preoperative risk score to predict occult metastatic or locally advanced disease in patients with resectable perihilar cholangiocarcinoma on Imaging
Abstract: Background: Many patients with resectable perihilar cholangiocarcinoma (PHC) on imaging are diagnosed intraoperatively with occult metastatic or locally advanced disease, precluding a curative-intent resection. This study aimed to develop and validate a preoperative risk score. Study Design: Patients with resectable PHC on imaging who underwent operations in 2 high-volume centers (US and Europe) between 2000 and 2015 were included. Multivariable logistic regression analysis was used to develop the risk score. Cross-validation was used to validate the score, alternating the 2 centers as “training” and “testing” datasets. Results: Of 566 patients who underwent operations, 309 (55%) patients had a resection, and in 257 (45%) patients, a curative-intent resection was precluded due to distant metastasis (n = 151 [27%]) or locally advanced disease (n = 106 [19%]). Preoperative predictors included bilirubin >2 mg/dL, bile duct involvement on imaging, portal vein involvement on imaging (≥180 degrees), hepatic artery involvement on imaging (≥180 degrees), and suspicious lymph nodes on imaging. The new risk score (c-index 0.75 after cross-validation) provided significantly more accurate predictions than the Bismuth classification (c-index 0.62), Blumgart T-staging (c-index 0.67), and cTNM staging (c-index 0.68). The new risk score identified 4 risk groups for occult metastatic or locally advanced disease: low (14.7%), intermediate (29.5%), high (47.3%), and very high risk (81.3%). The preoperative score groups also predicted survival after operation, irrespective of intraoperative findings (p < 0.001). Conclusions: The validated risk score can predict occult distant metastatic or locally advanced PHC based on 5 preoperatively available factors. The score can be useful in preoperative shared decision making and selection of patients in neoadjuvant clinical trials. © 2018 American College of Surgeons
Journal Title: Journal of the American College of Surgeons
Volume: 227
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2018-08-01
Start Page: 238
End Page: 246.e2
Language: English
DOI: 10.1016/j.jamcollsurg.2018.03.041
PROVIDER: scopus
PUBMED: 29627334
DOI/URL:
Notes: Article -- Export Date: 1 August 2018 -- Source: Scopus
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MSK Authors
  1. Ronald P Dematteo
    574 Dematteo
  2. Peter Allen
    411 Allen
  3. William R Jarnagin
    554 Jarnagin
  4. T Peter Kingham
    268 Kingham