• Marc Perez, Carsten Palnaes Hansen, Fernando Burdio, Gianluca Pellino, Adolfo Pisanu, Roberto Salvia, Marcello Di Martino, Mohammad Abu Hilal, Luca Aldrighetti, Benedetto Ielpo, and and the Cholangiocarcinoma Multicenter Study Coauthor Group.
• From the Hepato Pancreato Biliary Division, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain (Perez, Burdio, Ielpo).
• J. Am. Coll. Surg. 2022 Nov 1; 235 (5): 703712703-712.

BackgroundSeveral variables have been described as prognostic factors for resected distal cholangiocarcinoma (dCC), including lymph node metastases (N status) and lymph node ratio (LNR). The present study aimed to evaluate the prognostic value of LNR on survival and to establish a novel prognostic nomogram to predict the cancer-specific recurrence-free survival (RFS) of dCC.Study DesignBetween December 2006 and September 2020, 415 consecutive patients who underwent pancreaticoduodenectomy (PD) for dCC in 10 centers were identified. Multivariate Cox analysis was used to identify all independent risk factors among several prognostic factors. A nomogram was then developed and assessed by integrating the independent prognostic factors into the model, and the concordance index (C-index) was used to evaluate its performance.ResultsAccording to Cox regression multivariate analysis, a nomogram based on independent prognostic factor for RFS was performed including LNR 15 (hazard ratio [HR] 2.442, 95% CI 1.348-4.425, p = 0.003), perineural invasion (HR 3.100, 95% CI 1.183-8.122, p = 0.025), differentiation grade (HR 2.100, 95% CI 1.172-4.143, p = 0.021), and radicality of PD (HR 2.276, 95% CI 1.223-4.234, p = 0.009). The C-index of the nomogram, tailored based on the previous significant factors, was 0.8.ConclusionsLNR15 yields a high prognostic efficiency for RFS. The nomogram based on LNR can provide an accurate prognosis assessment for patients with resected dCC.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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