Faculty Collaboration Database

Defining when to offer operative treatment for intrahepatic cholangiocarcinoma: A regret-based decision curves analysis. Surgery 2016 Jul;160(1):106-117

Date

04/06/2016

Pubmed ID

27046702

DOI

10.1016/j.surg.2016.01.023

Scopus ID

2-s2.0-84961885115 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

BACKGROUND: Regret-based decision curve analysis (DCA) is a framework that assesses the medical decision process according to physician attitudes (expected regret) relative to disease-based factors. We sought to apply this methodology to decisions around the operative management of intrahepatic cholangiocarcinoma (ICC).

METHODS: Utilizing a multicentric database of 799 patients who underwent liver resection for ICC, we developed a prognostic nomogram. DCA tested 3 strategies: (1) perform an operation on all patients, (2) never perform an operation, and (3) use the nomogram to select patients for an operation.

RESULTS: Four preoperative variables were included in the nomogram: major vascular invasion (HR = 1.36), tumor number (multifocal, HR = 1.18), tumor size (>5 cm, HR = 1.45), and suspicious lymph nodes on imaging (HR = 1.47; all P < .05). The regret-DCA was assessed using an online survey of 50 physicians, expert in the treatment of ICC. For a patient with a multifocal ICC, largest lesion measuring >5 cm, one suspicious malignant lymph node, and vascular invasion on imaging, the 1-year predicted survival was 52% according to the nomogram. Based on the therapeutic decision of the regret-DCA, 60% of physicians would advise against an operation for this scenario. Conversely, all physicians recommended an operation to a patient with an early ICC (single nodule measuring 3 cm, no suspicious lymph nodes, and no vascular invasion at imaging).

CONCLUSION: By integrating a nomogram based on preoperative variables and a regret-based DCA, we were able to define the elements of how decisions rely on medical knowledge (postoperative survival predicted by a nomogram, severity disease assessment) and physician attitudes (regret of commission and omission).

Author List

Bagante F, Spolverato G, Cucchetti A, Gani F, Popescu I, Ruzzenente A, Marques HP, Aldrighetti L, Gamblin TC, Maithel SK, Sandroussi C, Bauer TW, Shen F, Poultsides GA, Marsh JW, Guglielmi A, Pawlik TM

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Attitude of Health Personnel
Bile Duct Neoplasms
Bile Ducts, Intrahepatic
Cholangiocarcinoma
Clinical Decision-Making
Decision Support Techniques
Emotions
Female
Hepatectomy
Humans
Male
Middle Aged
Nomograms
Survival Rate