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Nomograms predict survival outcome of Klatskin tumors patients.

ABSTRACT: Objective:Klatskin tumors are rare, malignant tumors of the biliary system with a poor prognosis for patient survival. The current understanding of these tumors is limited to a small number of case reports or case series; therefore, we examined prognostic factors of this disease. Methods:A population cohort study was conducted in patients selected from the Surveillance, Epidemiology, and End Results (SEER) database with a Klatskin tumor that was histologically diagnosed between 2004 to 2014. Propensity-matching (PSM) analysis was performed to determine the overall survival (OS) among those with a Klatskin tumor (KCC), intrahepatic cholangiocarcinoma (ICCA), or hepatocellular carcinoma (HCC). The nomogram was based on 317 eligible Klatskin tumor patients and its predictive accuracy and discriminatory ability were determined using the concordance index (C-index). Results:Kaplan-Meier analysis showed that patients with Klatskin tumors had significantly worse overall survival rates (1-year OS = 26.2%, 2-year OS = 10.7%, 3-year OS = 3.4%) than those with intrahepatic cholangiocarcinoma (1-year OS = 62.2%, 2-year OS = 36.4%, 3-year OS = 19.1%, p < 0.001) or hepatocellular carcinoma (1-year OS = 72.4% , 2-year OS = 48.5%, 3-year OS = 36.2%, p < 0.001). A poor prognosis was also significantly associated with older age, higher grade, SEER historic stage, and lymph node metastasis. Local destruction of the tumor (HR = 0.635, 95% CI [0.421-0.956], p = 0.03) and surgery (HR = 0.434, 95% [CI 0.328-0.574], p < 0.001) were independent protective factors. Multivariate Cox analysis showed that older age, SEER historic stage, and lymph node metastases (HR = 1.468, 95% CI [1.008-2.139], p = 0.046) were independent prognostic factors of poor survival rates in Klatskin tumor patients, while cancer-directed surgery was an independent protective factor (HR = 0.555, 95% CI [0.316-0.977], p = 0.041). The prognostic and protective factors were included in the nomogram (C-index for survival = 0.651; 95% CI [0.607-0.695]). Conclusions:The Klatskin tumor group had poorer rates of OS and cancer-specific survival than the ICCA and HCC groups. Early detection and diagnosis were associated with a higher rate of OS in Klatskin tumor patients.

SUBMITTER: Qi F

PROVIDER: S-EPMC7034372 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Nomograms predict survival outcome of Klatskin tumors patients.

Qi Feng F Zhou Bin B Xia Jinglin J

PeerJ 20200218

<h4>Objective</h4>Klatskin tumors are rare, malignant tumors of the biliary system with a poor prognosis for patient survival. The current understanding of these tumors is limited to a small number of case reports or case series; therefore, we examined prognostic factors of this disease.<h4>Methods</h4>A population cohort study was conducted in patients selected from the Surveillance, Epidemiology, and End Results (SEER) database with a Klatskin tumor that was histologically diagnosed between 20 ...[more]

PMID: 32110489

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Project description:ObjectiveProstate cancer (PC) is the most common non-cutaneous malignancy in men worldwide. Accurate predicting the survival of elderly PC patients can help reduce mortality in patients. We aimed to construct nomograms to predict cancer-specific survival (CSS) and overall survival (OS) in elderly PC patients.MethodsInformation on PC patients aged 65 years and older was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to determine independent risk factors for PC patients. Nomograms were developed to predict the CSS and OS of elderly PC patients based on a multivariate Cox regression model. The accuracy and discrimination of the prediction model were tested by the consistency index (C-index), the area under the subject operating characteristic curve (AUC), and the calibration curve. Decision curve analysis (DCA) was used to test the clinical value of the nomograms compared with the TNM staging system and D'Amico risk stratification system.Results135183 elderly PC patients in 2010-2018 were included. All patients were randomly assigned to the training set (N=94764) and the validation set (N=40419). Univariate and multivariate Cox regression model analysis revealed that age, race, marriage, histological grade, TNM stage, surgery, chemotherapy, radiotherapy, biopsy Gleason score (GS), and prostate-specific antigen (PSA) were independent risk factors for predicting CSS and OS in elderly patients with PC. The C-index of the training set and the validation set for predicting CSS was 0.883(95%CI:0.877-0.889) and 0.887(95%CI:0.877-0.897), respectively. The C-index of the training set and the validation set for predicting OS was 0.77(95%CI:0.766-0.774)and 0.767(95%CI:0.759-0.775), respectively. It showed that the proposed model has excellent discriminative ability. The AUC and the calibration curves also showed good accuracy and discriminability. The DCA showed that the nomograms for CSS and OS have good clinical potential value.ConclusionsWe developed new nomograms to predict CSS and OS in elderly PC patients. The models have been internally validated with good accuracy and reliability and can help doctors and patients to make better clinical decisions.

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Nomograms predict survival outcome of Klatskin tumors patients.

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Nomograms predict survival outcome of Klatskin tumors patients.

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