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KMID : 0939920170490041127
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대한암학회지
2017 Volume.49 No. 4 p.1127 ~ p.1139
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Prognostic Factors and Scoring Model for Survival in Metastatic Biliary Tract Cancer
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Park Hyung-Soon
Park Ji-Soo
Chun You-Jin
Roh Yun-Ho
Moon Ji-Eun
Chon Hong-Jae
Choi Hye-Jin
Park Joon-Seong
Lee Dong-Ki
Lee Se-Joon
Yoon Dong-Sup
Jeung Hei-Cheul
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Abstract
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Purpose: Metastatic biliary tract cancer (mBTC) has a dismal prognosis. In this study, an independent dataset of patients with mBTC was used to implement and validate a routine clinico-laboratory parameter-based scoring model for risk group identification.
Materials and Methods: From September 2006 to February 2015, 482 patients with mBTC were assigned randomly (ratio, 7:3) into investigational (n=340) and validation datasets (n=142). The continuous variables were dichotomized using a normal range or the best cutoff values determined using the Contal and O'Quigley statistical methods. Following a Cox’s proportional hazard model, the scoring model was derived by summing the rounded chi-square scores for the factors identified by multivariate analysis.
Results: The performance status (Eastern Cooperative Oncology Group 3-4), hypoalbuminemia (< 3.4 mg/dL), carcinoembryonic antigen (≥ 9 ng/mL), neutrophil-to-lymphocyte ratio (≥ 3.0), and carbohydrate antigen 19-9 (≥ 120 U/mL) were identified as independent prognosticators (Harrell’s C index, 0.682; integrated area under the curve, 0.653). Survival was clearly correlated with the risk groups (low, intermediate, and high, 14.0, 7.3, and 2.3 months, respectively; p < 0.001). The prognosis was also discriminative in the validation data set (median survival, 16.7, 7.5, and 1.9 months, respectively; p < 0.001). Chemotherapy did not offer any survival benefits for high-risk patients.
Conclusion: These proposed prognostic criteria for mBTC can facilitate accurate patient risk stratification and treatment-related decision-making.
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KEYWORD
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Biliary tract neoplasms, Prognosis, Scoring model, Survival, Validation, Drug therapy
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