Analysis of prognostic factors for R1/R2 resection in patients with hilar cholangiocarcinoma.

Abstract

Objective: To identify prognostic factors and develop a predictive tool for patients with hilar cholangiocarcinoma (HCCA) undergoing R1 or R2 resection, thereby informing patient selection and individualized treatment decisions.

Methods: A retrospective analysis was conducted of HCCA patients who underwent R1 or R2 resection at a single center. Independent prognostic factors were identified using Cox regression analysis, and a predictive nomogram was constructed using R software.

Results: Multivariate analysis identified four independent prognostic factors: surgical margin status (P = 0.002), tumor differentiation grade (P = 0.030), vascular invasion (P < 0.001), and adjuvant therapy (P = 0.023). The nomogram based on these factors demonstrated favorable discriminatory ability, with a C-index of 0.780. Time-dependent receiver operating characteristic (ROC) analysis yielded areas under the curve (AUC) of 0.904 (95% confidence interval [CI]: 0.831-0.966) and 0.822 (95% CI: 0.736-0.897) for predicting 1-year and 2-year survival, respectively. Patients stratified into high-risk and low-risk groups by the nomogram showed significantly different survival outcomes (1-year survival: 44% vs. 92.5%; 2-year survival: 20% vs. 52.8%).

Conclusion: The developed nomogram effectively predicts prognosis following R1 or R2 resection for HCCA, demonstrating good discrimination and short-term predictive accuracy. It serves as a useful tool for postoperative risk stratification and personalized management planning.