Survival prediction for patients with malignant biliary obstruction caused by biliary tract cancer undergoing percutaneous biliary decompression

Table 1 Clinical characteristics of patients with biliary tract cancer-malignant biliary obstruction in the training and validation groups, n (%)

Characteristics	Total (n = 284)	Training (n = 204)	Validation (n = 80)	P value
Gender				0.105
Female	110 (38.7)	85 (41.7)	25 (31.3)
Male	174 (61.3)	119 (58.3)	55 (68.8)
Age	65.9 (10.3)	66.0 (10.4)	65.8 (10.2)	0.917
Bismuth type				0.158
I	44 (15.5)	31 (15.2)	13 (16.3)
II	116 (40.8)	76 (37.3)	40 (50.0)
III	116 (40.8)	90 (44.1)	26 (32.5)
IV	8 (2.8)	7 (3.4)	1 (1.3)
Interventions				0.995
Plastic catheter	168 (59.2)	121 (59.3)	47 (58.8)
Metal stent	91 (32.0)	65 (31.9)	26 (32.5)
Irradiation stent	25 (8.8)	18 (8.8)	7 (8.8)
Subtype of tumor				0.509
ICC	55 (19.4)	37 (18.1)	18 (22.5)
PCC	145 (51.1)	102 (50.0)	43 (53.8)
DCC	62 (21.8)	49 (24.0)	13 (16.3)
GBC	22 (7.7)	16 (7.8)	6 (7.5)
M stage				0.676
0	235 (82.7)	170 (83.3)	65 (81.3)
1	49 (17.3)	34 (16.7)	15 (18.8)
History of surgery				0.405
No	214 (75.4)	151 (74.0)	63 (78.8)
Yes	70 (24.6)	53 (26.0)	17 (21.3)
Subsequent surgery				0.817
No	261 (91.9)	187 (91.7)	74 (92.5)
Yes	23 (8.1)	17 (8.3)	6 (7.5)
Subsequent chemotherapy				0.594
No	251 (88.4)	179 (87.7)	72 (90.0)
Yes	33 (11.6)	25 (12.3)	8 (10.0)
Subsequent radiotherapy				0.293
No	242 (85.2)	171 (83.8)	71 (88.8)
Yes	42 (14.8)	33 (16.2)	9 (11.3)
Subsequent targeted therapy				0.527
No	278 (97.9)	199 (97.5)	79 (98.8)
Yes	6 (2.1)	5 (2.5)	1 (1.3)
Gallstones				0.603
No	236 (83.1)	171 (83.8)	65 (81.3)
Yes	48 (16.9)	33 (16.2)	15 (18.8)
Hydrothorax				0.470
No	257 (90.5)	183 (89.7)	74 (92.5)
Yes	27 (9.5)	21 (10.3)	6 (7.5)
Ascites				0.293
No	242 (85.2)	171 (83.8)	71 (88.8)
Yes	42 (14.8)	33 (16.2)	9 (11.3)
Hydrops				0.285
No	234 (82.4)	165 (80.9)	69 (86.3)
Yes	50 (17.6)	39 (19.1)	11 (13.8)
ALT (IU/L)	116 (102)	117 (105)	120 (93)	0.690
AST (IU/L)	122 (108)	123 (103)	119 (122)	0.806
γ-GT (IU/L)	513 (367)	505 (355)	533 (397)	0.568
AKP (IU/L)	626 (413)	603 (394)	687 (455)	0.125
ALB (g/L)	32.1 (5.11)	32.3 (5.12)	31.6 (5.06)	0.271
GLB (g/L)	26.4 (IQR: 23.5, 31.8)	25.7 (IQR: 23.4, 31.9)	27.6 (IQR: 24.7, 30.7)	0.122
TB (μmol/L)	238 (151)	239 (155)	234 (139)	0.798
DB (μmol/L)	169 (106)	169 (109)	170 (101)	0.977
TB/DB	1.41 (IQR: 1.37, 1.46)	1.41 (IQR: 1.37, 1.46)	1.41 (IQR: 1.36, 1.44)	0.331
TC (mmol/L)	5.93 (3.93)	6.09 (4.22)	5.51 (3.05)	0.265
TG (mmol/L)	2.29 (IQR: 1.41, 3.12)	2.24 (IQR: 1.36, 3.03)	2.37 (IQR: 1.57, 3.33)	0.137
BUN (mmol/L)	5.35 (4.65)	5.10 (4.16)	5.99 (5.68)	0.147
Cr (μmol/L)	62.6 (37.6)	59.0 (19.0)	71.7 (63.1)	0.010
K (mmol/L)	3.72 (0.50)	3.68 (0.48)	3.82 (0.53)	0.024
Na (mmol/L)	136 (8.68)	136 (3.66)	134 (15.25)	0.112
Cl (mmol/L)	101 (4.96)	101 (4.65)	101 (5.69)	0.564
Ca (mmol/L)	2.37 (2.92)	2.44 (3.44)	2.19 (0.14)	0.519
Glu (mmol/L)	5.87 (1.98)	5.90 (1.81)	5.81 (2.38)	0.740
WBC (× 109/L)	8.15 (3.80)	8.12 (3.70)	8.22 (4.07)	0.836
N percentage	73.3 (12.3)	73.2 (11.6)	73.5 (14.0)	0.863
L percentage	16.3 (9.13)	16.5 (8.71)	16.0 (10.2)	0.703
NLR	7.49 (12.7)	7.84 (14.7)	6.59 (5.00)	0.458
Hb (g/L)	110 (18.2)	110 (18.6)	109 (17.0)	0.652
PLT (× 109/L)	227 (98.0)	230 (98.3)	219 (97.1)	0.397
CEA (ng/mL)				0.872
< 5	149 (55.8)	106 (55.5)	43 (56.6)
≥ 5	118 (44.2)	85 (44.5)	33 (43.4)
CA19-9 (U/mL)				0.977
< 1000	152 (56.7)	109 (56.8)	43 (56.6)
≥ 1000	116 (43.3)	83 (43.2)	33 (43.4)
HBP				0.310
No	180 (63.4)	133 (65.2)	47 (58.8)
Yes	104 (36.6)	71 (34.8)	33 (41.3)
Diabetes				0.420
No	242 (85.2)	176 (86.3)	66 (82.5)
Yes	42 (14.8)	28 (13.7)	14 (17.5)
Smoke				0.574
No	233 (82.0)	169 (82.8)	64 (80.0)
Yes	51 (18.0)	35 (17.2)	16 (20.0)
Alcohol				0.487
No	241 (84.9)	175 (85.8)	66 (82.5)
Yes	43 (15.1)	29 (14.2)	14 (17.5)
ECOG PS score				0.600
0	25 (8.8)	17 (8.3)	8 (10.0)
1	214 (75.4)	157 (77.0)	57 (71.3)
2 or 3	45 (15.8)	30 (14.7)	15 (18.8)

ICC: Intrahepatic cholangiocarcinoma; PCC: Perihilar cholangiocarcinoma; DCC: Distal cholangiocarcinoma; GBC: Gallbladder carcinoma; M stage: Metastasis stage; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; γ-GT: γ-glutamyl transpeptidase; AKP: Alkaline phosphatase; ALB: Albumin; GLB: Globulin; TB: Total bilirubin; DB: Direct bilirubin; TC: Total cholesterol; TG: Triglycerides; BUN: Blood urea nitrogen; Cr: Creatinine; K: Potassium; Na: Sodium; Cl: Chloride; Ca: Calcium; Glu: Glucose; WBC: White blood cell; N: Neutrophil; L: Lymphocyte; NLR: Neutrophil-to-lymphocyte ratio; Hb: Hemoglobin; PLT: Platelet; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; HBP: Hypertension; ECOG PS: Eastern Cooperative Oncology Group Performance Status.

Table 2 Univariate analysis and multivariate analysis of factors associated with overall survival in patients with biliary tract cancer-malignant biliary obstruction in the training group

Characteristics	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Gender		0.255
Female
Male	1.209 (0.872-1.677)
Age	1.020 (1.003-1.036)	0.019
Bismuth type		0.078
I
II	0.388 (0.162-0.926)
III	0.466 (0.212-1.025)
IV	0.606 (0.277-1.325)
Interventions		0.522
Plastic catheter
Metal stent	0.754 (0.447-1.274)
Irradiation seeds	0.853 (0.491-1.481)
Subtype of tumor		0.002		0.002
ICC
PCC	0.781 (0.418-1.457)		0.535 (0.344-0.833)
DCC	0.445 (0.250-0.790)		0.479 (0.285-0.804)
GBC	0.403 (0.213-0.762)		1.266 (0.648-2.477)
M stage		0.022
0
1	1.596 (1.069-2.383)
History of surgery		0.267
No
Yes	1.231 (0.853-1.776)
Subsequent surgery		< 0.001		< 0.001
No
Yes	0.230 (0.101-0.526)		0.226 (0.096-0.530)
Subsequent chemotherapy		0.002
No
Yes	0.376 (0.203-0.695)
Subsequent radiotherapy		0.152
No
Yes	0.714 (0.450-1.132)
Subsequent targeted therapy		0.041
No
Yes	0.234 (0.058-0.944)
Gallstones		0.683
No
Yes	0.915 (0.596-1.404)
Hydrothorax		0.367
No
Yes	1.254 (0.767-2.053)
Ascites		0.008
No
Yes	1.714 (1.149-2.558)
Hydrops		0.043
No
Yes	1.483 (1.012-2.173)
ALT (IU/L)	1.000 (0.998-1.001)	0.713
AST (IU/L)	1.001 (1.000-1.003)	0.037
γ-GT (IU/L)	1.000 (0.999-1.000)	0.298
AKP (IU/L)	1.000 (1.000-1.001)	0.208
ALB (g/L)	0.922 (0.893-0.952)	< 0.001
GLB (g/L)	1.009 (0.986-1.033)	0.433
TB (μmol/L)	1.002 (1.001-1.003)	< 0.001	1.002 (1.001-1.004)	< 0.001
DB (μmol/L)	1.003 (1.002-1.005)	< 0.001
TB/DB	0.655 (0.280-1.531)	0.329
TC (mmol/L)	0.944 (0.894-0.997)	0.039	0.913 (0.856-0.973)	0.005
TG (mmol/L)	0.965 (0.855-1.090)	0.569
BUN (mmol/L)	1.054 (1.023-1.086)	< 0.001
Cr (μmol/L)	1.005 (1.001-1.008)	0.005
K (mmol/L)	0.621 (0.429-0.898)	0.011
Na (mmol/L)	0.897 (0.859-0.936)	< 0.001	0.918 (0.876-0.963)	< 0.001
Cl (mmol/L)	0.939 (0.903-0.977)	0.002
Ca (mmol/L)	0.153 (0.050-0.462)	< 0.001
Glu (mmol/L)	0.943 (0.856-1.039)	0.235
WBC (× 109/L)	1.099 (1.049-1.152)	< 0.001
N percentage	1.017 (1.001-1.033)	0.032
L percentage	0.968 (0.949-0.988)	0.002
NLR	1.008 (1.000-1.015)	0.055
Hb (g/L)	0.988 (0.981-0.995)	0.001	0.984 (0.974-0.994)	0.001
PLT (× 109/L)	0.999 (0.998-1.001)	0.344
CEA (ng/mL)		< 0.001
< 5
≥ 5	1.758 (1.269-2.436)
CA19-9 (U/mL)		< 0.001		< 0.001
< 1000
≥ 1000	2.552 (1.835-3.548)		1.898 (1.296-2.781)
HBP		0.017
No
Yes	1.480 (1.074-2.038)
Diabetes		0.826
No
Yes	1.052 (0.669-1.655)
Smoke		0.331
No
Yes	1.208 (0.826-1.768)
ECOG PS score		0.002
0
1	0.369 (0.192-0.712)
2 or 3	0.524 (0.349-0.788)

ICC: Intrahepatic cholangiocarcinoma; PCC: Perihilar cholangiocarcinoma; DCC: Distal cholangiocarcinoma; GBC: Gallbladder carcinoma; M stage: Metastasis stage; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; γ-GT: γ-glutamyl transpeptidase; AKP: Alkaline phosphatase; ALB: Albumin; GLB: Globulin; TB: Total bilirubin; DB: Direct bilirubin; TC: Total cholesterol; TG: Triglycerides; BUN: Blood urea nitrogen; Cr: Creatinine; K: Potassium; Na: Sodium; Cl: Chloride; Ca: Calcium; Glu: Glucose; WBC: White blood cell; N: Neutrophil; L: Lymphocyte; NLR: Neutrophil-to-lymphocyte ratio; Hb: Hemoglobin; PLT: Platelet; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; HBP: Hypertension; ECOG PS: Eastern Cooperative Oncology Group Performance Status; HR: Hazard ratio; CI: Confidence interval.