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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2021; 13(8): 929-942
Published online Aug 15, 2021. doi: 10.4251/wjgo.v13.i8.929
Diffuse reduction of spleen density is a novel prognostic marker for intrahepatic cholangiocarcinoma after curative resection
Li-Ming Deng, Yi Wang, Jin-Huan Yang, Jia-Liang Li, Zi-Yan Chen, Wen-Ming Bao, Kai-Yu Chen, Xin-Fei Yao, Chong-Ming Zheng, Jiu-Yi Zheng, Zheng-Ping Yu, Bin Jin, Gang Chen
Li-Ming Deng, Jin-Huan Yang, Jia-Liang Li, Zi-Yan Chen, Wen-Ming Bao, Kai-Yu Chen, Chong-Ming Zheng, Jiu-Yi Zheng, Zheng-Ping Yu, Gang Chen, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Li-Ming Deng, Jin-Huan Yang, Jia-Liang Li, Zi-Yan Chen, Wen-Ming Bao, Kai-Yu Chen, Chong-Ming Zheng, Jiu-Yi Zheng, Zheng-Ping Yu, Gang Chen, Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Yi Wang, Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Xin-Fei Yao, Division of Clinical Medicine, First School of Clinical Medicine,Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
Bin Jin, Department of Hepatobiliary Surgery, Qilu Hospital Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Deng LM, Wang Y, and Yang JH contributed equally to this work; Deng LM, Wang Y, Yang JH, Jin B, Yu ZP, and Chen G conceptualized and designed the study; Chen KY, Yao XF, Bao WM, Li JL, Chen ZY, Zheng CM, and Zheng JY collected the data and performed the analyses; Deng LM and Wang Y drafted the initial version of the manuscript; Jin B and Chen G had full access to all data in the study and had responsibility for the integrity of the data, accuracy of the analyses, and final decision to submit the manuscript for publication; All authors contributed to the interpretation of the results, critically reviewed revisions of the manuscript, and contributed important intellectual content.
Supported by National Natural Science Foundation of China, No. 82072685; and the Science and Technology Innovation Program for College Students in Zhejiang Province, No. 2020R413022.
Institutional review board statement: This study was reviewed and approved for publication by the Research Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University and Qilu Hospital Shandong University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
chen.gang@wmu.edu.cn.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Gang Chen, MD, PhD, Chief Doctor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Fuxue Road, Wenzhou 325035, Zhejiang Province, China.
chen.gang@wmu.edu.cn
Received: February 20, 2021
Peer-review started: February 20, 2021
First decision: May 3, 2021
Revised: May 14, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 15, 2021
Processing time: 175 Days and 8.9 Hours
BACKGROUND
Diffuse reduction of spleen density (DROSD) is related to cancer prognosis; however, its role in intrahepatic cholangiocarcinoma (ICC) remains unclear.
AIM
To assess the predictive value of DROSD in the prognosis of ICC after curative resection.
METHODS
In this multicenter retrospective cohort study, we enrolled patients with ICC who underwent curative hepatectomy between 2012 and 2019. Preoperative spleen density was measured using computed tomography. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated and compared utilizing the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were applied to identify independent factors for OS and RFS. A nomogram was created with independent risk factors to predict prognosis of patients with ICC.
RESULTS
One hundred and sixty-seven ICC patients were enrolled. Based on the diagnostic cut-off values (spleen density ≤ 45.5 Hounsfield units), 55 (32.9%) patients had DROSD. Kaplan–Meier analysis indicated that patients with DROSD had worse OS and RFS than those without DROSD (P < 0.05). Cox regression analysis revealed that DROSD, carcinoembryonic antigen level, carbohydrate antigen 19-9 level, length of hospital stay, lymph node metastasis, and postoperative complications were independent predictors for OS (P < 0.05). The nomogram created with these factors was able to predict the prognosis of patients with ICC with good reliability (OS C-index = 0.733). The area under the curve for OS was 0.79.
CONCLUSION
ICC patients with DROSD have worse OS and RFS. The nomogram is a simple and practical method to identify high-risk ICC patients with poor prognosis.
Core Tip: This study provides a new indicator for prognosis in intrahepatic cholangiocarcinoma (ICC) patients who have undergone hepatectomy. We believe that our study makes a significant contribution because it gives clinicians a tool to classify high-risk ICC patients who have a poor prognosis after hepatectomy. This tool is a nomogram that we developed using conventional indicators and diffuse reduction of spleen density. The use of this nomogram allows clinicians to take measures to improve the outcomes of patients who have been classified as high risk.
