Defining when to offer operative treatment for intrahepatic cholangiocarcinoma: A regret-based decision curves analysis

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• 作者：Fabio Bagante ; MD^a ; Gaya Spolverato ; MD^a ; Alessandro Cucchetti ; MD^b ; Faiz Gani ; MBBS^a ; Irinel Popescu ; MD^c ; Andrea Ruzzenente ; MD^d ; Hugo P. Marques ; MD^e ; Luca Aldrighetti ; MD^f ; T. Clark Gamblin ; MD^g ; Shishir K. Maithel ; MD^h ; Charbel Sandroussi ; MDⁱ ; Todd W. Bauer ; MD^j ; Feng Shen ; MD^k ; George A. Poultsides ; MD^l ; James Wallis Marsh ; MD^m ; Alfredo Guglielmi ; MD^d ; Timothy M. Pawlik ; MD ; MPH ; PhD ; FACS^a ; ^{tpawlik1@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Surgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：160
• 期：1
• 页码：106-117
• 全文大小：621 K

文摘

Regret-based decision curve analysis (DCA) is a framework that assesses the medical decision process according to physician attitudes (expected regret) relative to disease-based factors. We sought to apply this methodology to decisions around the operative management of intrahepatic cholangiocarcinoma (ICC).

absSec_2">Methods

abspara0015">Utilizing a multicentric database of 799 patients who underwent liver resection for ICC, we developed a prognostic nomogram. DCA tested 3 strategies: (1) perform an operation on all patients, (2) never perform an operation, and (3) use the nomogram to select patients for an operation.

absSec_3">Results

abspara0020">Four preoperative variables were included in the nomogram: major vascular invasion (HR = 1.36), tumor number (multifocal, HR = 1.18), tumor size (>5 cm, HR = 1.45), and suspicious lymph nodes on imaging (HR = 1.47; all P < .05). The regret-DCA was assessed using an online survey of 50 physicians, expert in the treatment of ICC. For a patient with a multifocal ICC, largest lesion measuring >5 cm, one suspicious malignant lymph node, and vascular invasion on imaging, the 1-year predicted survival was 52% according to the nomogram. Based on the therapeutic decision of the regret-DCA, 60% of physicians would advise against an operation for this scenario. Conversely, all physicians recommended an operation to a patient with an early ICC (single nodule measuring 3 cm, no suspicious lymph nodes, and no vascular invasion at imaging).

absSec_4">Conclusion

abspara0025">By integrating a nomogram based on preoperative variables and a regret-based DCA, we were able to define the elements of how decisions rely on medical knowledge (postoperative survival predicted by a nomogram, severity disease assessment) and physician attitudes (regret of commission and omission).