Related Experiment Video
Updated: Sep 16, 2025
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
Preoperative risk stratification for multifocal intrahepatic cholangiocarcinoma after liver resection: a multicenter
Jun Fu1, Qizhu Lin2, Lifang Zheng3
1Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350000, Fujian, China.
Background And Aim:
The prognostic significance of liver resection for multifocal intrahepatic cholangiocarcinoma (ICC) remains controversial and is further complicated by the lack of reliable predictive models. This study aims to develop a prognostic Classification and Regression Tree (CART) model for resectable multifocal ICC.
Methods:
This retrospective, multicenter cohort study included 283 patients who underwent liver resection for multifocal ICC between 2008 and 2020. Prognostic variables identified via multivariable Cox regression were used to construct a CART model. The predictive accuracy of the CART model was internally validated through 5-fold cross-validation and compared to Wang and Hyder nomogram.
Results:
Bilobar tumors, largest tumor size >6 cm, tumor number >2, and Carbohydrate Antigen 19-9 >37 U/mL were associated with poorer survival. The CART model stratified patients into three risk groups. Patients with two unilobar tumors and largest tumor size ≤6 cm had the most favorable prognosis, with a median OS of 37.5 months and 5-year OS of 25.6 %. In contrast, those with bilobar involvement and CA19-9 >37 U/mL had the poorest outcomes, with a median OS of 11.2 months and 5-year OS of 0 %, regardless of tumor size or number. The area under the receiver operating characteristic curve (AUC) of the CART model in internal validation was 0.728. The time-dependent AUC for the CART model was 0.711, exceeding that of the Wang (0.644) and Hyder (0.618) nomograms.
Conclusion:
The CART model provides accurate and interpretable survival prediction for patients with resectable multifocal ICC and may assist in preoperative surgical decision-making.
