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Prognostic significance of advanced age in patients with intrahepatic cholangiocarcinoma: A retrospective study of the SEER database

Zheng Wang, Xiang-Yu Wang, Jian-Hua Li, Xin Yang, Wen-Wei Zhu

This study analyzed the prognostic significance of age in patients with intrahepatic cholangiocarcinoma (ICC). Cases diagnosed with ICC between 1988 and 2009 were extracted from the Surveillance, Epidemiology and End Results (SEER) database as the primary cohort. The enrolled patients were divided into 2 groups: the elderly group (≥ 65 y of age) and young group (<65 y of age). The 1, 3 and 5-y cancer-specific survival (CSS) rates were obtained. Kaplan-Meier curves were applied and multivariable Cox regression models were built to analyze the risk factors for prognosis. A multifactorial, integrative nomogram for prognostic prediction was formulated by software R. Cases diagnosed in 2010 from the SEER database were enrolled as the validation cohort. In total, 2161 patients were ultimately included in the primary cohort. The 1, 3 and 5-y CSS rates were 34.3%, 12.5% and 6.5% in the elderly group and 49.8%, 21.3% and 11.5% in the young group, respectively. Univariate (P=0.001) and multivariate (P<0.001) analysis revealed a significant difference in CSS between the two groups. Clinical variables including age, pathological grade, primary tumor stage, lymph node invasion and metastasis were integrated to formulate the nomogram for prognostic prediction, and its predictive power was higher than that of conventional TNM staging. The results were confirmed in the validation cohort. In conclusion, aging could provide important prognostic information for ICC patients and further serve as a critical stratification parameter for the choice of treatment.