Nomogram Could Help Predict Early Recurrence Risk in ICC

The tool could help clinicians better screen patients for adjuvant chemotherapy following curative resection for intrahepatic cholangiocarcinoma (ICC).

A team of investigators has developed a nomogram they say can help clinicians better screen patients with intrahepatic cholangiocarcinoma (ICC) for adjuvant chemotherapy (ACT) by predicting the patients most likely to have early recurrence.

The prediction model could be important because patients with ICC are often difficult to treat. Only about 15% of patients with ICC are eligible for surgery, and surgical resection is the only available treatment that is considered curative. Even for patients who undergo surgery, the 3- year relapse-free survival (RFS) rate is under 30%.

In a new study published in Frontiers in Oncology, the investigators explained how they arrived at the nomogram.

“Therefore, identifying patients who are at risk for early recurrence is important to construct individualized surveillance strategies for ICC patients after radical resection,” the authors wrote.

ACT is thought to have the potential to improve the prognosis of these patients, but they said said its impact remains controversial. One problem is that it is unclear which patients are most likely to benefit from the therapy.

The investigators used a data set of 310 patients with ICC who underwent radical resection between 2010 and 2018. An external validation cohort was created based on 134 patients.

The data confirmed that early recurrence (within 1 year) had a dramatic impact on patient outcomes, and the authors found that ACT was associated with better outcomes. Among patients with early recurrence, the median overall survival (OS) was 14.0 months for patients not receiving ACT and 15.0 months for patients who underwent chemotherapy. The median RFS were 6.0 and 8.0 months, respectively.

However, in patients with late recurrence, the gap between those who underwent ACT and those who did not was even wider. Patients in the non-ACT group had a median OS of 41.0 months and a median RFS of 20.0 months. Those who had ACT had a median OS of 84.0 months and a median RFS of 45.0 months.

The investigators found several factors that appeared to be important in predicting patients most likely to experience early recurrence. Those factors included CA19-9, tumor size, major vascular invasion, microvascular invasion, and N stage.

Using those factors, the authors constructed a nomogram with a concordance index score of 0.777 (95% CI, 0.713-0.841) in the training set and 0.716 (95% CI, 0.604 0.828) in the validation set. Those scores indicate a “good” level of prediction.

The authors said their model has limitations, including its retrospective nature and the relatively small data set. They said larger data sets would be needed to further validate and improve the model.

However, they said the nomogram, or an improved version of it, has potential to help clinicians make decisions that lead to the best possible outcomes in a difficult treatment category.

“We expect that the nomogram model can help to screen appropriate ICC patients who could benefit from ACT and achieve widespread clinical application in the future,” they wrote.


Li Q, Zhang J, Chen C, et al. A nomogram model to predict early recurrence of patients with intrahepatic cholangiocarcinoma for adjuvant chemotherapy guidance: a multi-institutional analysis. Front Oncol. Published online June 23, 2022. doi:10.3389/fonc.2022.896764

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