Development and validation of a prognostic nomogram for postoperative survival in hilar cholangiocarcinoma using SEER...

The AJCC 8th edition TNM staging inadequately predicts survival for hilar cholangiocarcinoma (HCCA) patients post-resection. We developed/validated a prognostic nomogram for individualized survival estimation.

Data from SEER (2000-2021, n = 170) and an institutional cohort (n = 42) of resected HCCA patients were analyzed. Independent prognostic factors were identified via multivariate Cox regression. A nomogram predicting 1-, 3-, and 5-year overall survival (OS) was built and assessed using C-index, ROC curves, calibration, and decision curve analysis (DCA).

Independent prognostic factors included age >70 (HR = 2.73, p = 0.005), high tumor grade (HR = 1.98, p = 0.027), advanced T-stage (T3 HR = 2.66, T4 HR = 4.05, p < 0.05), N2 stage (HR = 7.49, p < 0.001), tumor size >5 cm (HR = 2.22, p = 0.033), and adjuvant chemotherapy (protective, HR = 0.60, p = 0.006). The nomogram demonstrated good discrimination (C-index 0.708 training, 0.696 validation) and calibration. DCA showed superior clinical utility versus TNM staging. Patients scoring ≥153.78 had significantly worse survival (1-year OS: 37.0 % vs 81.0 %, p < 0.001).

This validated nomogram, incorporating age, grade, T/N stage, size, and chemotherapy, provides accurate individualized OS prediction post-HCCA resection, surpassing TNM staging. It offers valuable guidance for risk stratification and treatment decisions, supporting clinical integration.