Defining when to offer operative treatment for intrahepatic cholangiocarcinoma

A regret-based decision curves analysis

Fabio Bagante, Gaya Spolverato, Alessandro Cucchetti, Faiz Gani, Irinel Popescu, Andrea Ruzzenente, Hugo P. Marques, Luca Aldrighetti, T. Clark Gamblin, Shishir K. Maithel, Charbel Sandroussi, Todd W. Bauer, Feng Shen, George A. Poultsides, James Wallis Marsh, Alfredo Guglielmi, Timothy M. Pawlik

Research output: Contribution to journalArticle

11 Citations (Scopus)

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).

Original languageEnglish
JournalSurgery
DOIs
Publication statusAccepted/In press - 2016

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Nomograms
Cholangiocarcinoma
Decision Support Techniques
Emotions
Physicians
Blood Vessels
Lymph Nodes
Therapeutics
Survival
Neoplasms
Databases
Liver

ASJC Scopus subject areas

  • Surgery

Cite this

Bagante, F., Spolverato, G., Cucchetti, A., Gani, F., Popescu, I., Ruzzenente, A., ... Pawlik, T. M. (Accepted/In press). Defining when to offer operative treatment for intrahepatic cholangiocarcinoma: A regret-based decision curves analysis. Surgery. https://doi.org/10.1016/j.surg.2016.01.023

Defining when to offer operative treatment for intrahepatic cholangiocarcinoma : A regret-based decision curves analysis. / Bagante, Fabio; Spolverato, Gaya; Cucchetti, Alessandro; Gani, Faiz; Popescu, Irinel; Ruzzenente, Andrea; Marques, Hugo P.; Aldrighetti, Luca; Gamblin, T. Clark; Maithel, Shishir K.; Sandroussi, Charbel; Bauer, Todd W.; Shen, Feng; Poultsides, George A.; Marsh, James Wallis; Guglielmi, Alfredo; Pawlik, Timothy M.

In: Surgery, 2016.

Research output: Contribution to journalArticle

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 2016, 'Defining when to offer operative treatment for intrahepatic cholangiocarcinoma: A regret-based decision curves analysis', Surgery. https://doi.org/10.1016/j.surg.2016.01.023
Bagante, Fabio ; Spolverato, Gaya ; Cucchetti, Alessandro ; Gani, Faiz ; Popescu, Irinel ; Ruzzenente, Andrea ; Marques, Hugo P. ; Aldrighetti, Luca ; Gamblin, T. Clark ; Maithel, Shishir K. ; Sandroussi, Charbel ; Bauer, Todd W. ; Shen, Feng ; Poultsides, George A. ; Marsh, James Wallis ; Guglielmi, Alfredo ; Pawlik, Timothy M. / Defining when to offer operative treatment for intrahepatic cholangiocarcinoma : A regret-based decision curves analysis. In: Surgery. 2016.
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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 = "Fabio Bagante and Gaya Spolverato and Alessandro Cucchetti and Faiz Gani and Irinel Popescu and Andrea Ruzzenente and Marques, {Hugo P.} and Luca Aldrighetti and Gamblin, {T. Clark} and Maithel, {Shishir K.} and Charbel Sandroussi and Bauer, {Todd W.} and Feng Shen and Poultsides, {George A.} and Marsh, {James Wallis} and Alfredo Guglielmi and Pawlik, {Timothy M.}",
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T1 - Defining when to offer operative treatment for intrahepatic cholangiocarcinoma

T2 - A regret-based decision curves analysis

AU - Bagante, Fabio

AU - Spolverato, Gaya

AU - Cucchetti, Alessandro

AU - Gani, Faiz

AU - Popescu, Irinel

AU - Ruzzenente, Andrea

AU - Marques, Hugo P.

AU - Aldrighetti, Luca

AU - Gamblin, T. Clark

AU - Maithel, Shishir K.

AU - Sandroussi, Charbel

AU - Bauer, Todd W.

AU - Shen, Feng

AU - Poultsides, George A.

AU - Marsh, James Wallis

AU - Guglielmi, Alfredo

AU - Pawlik, Timothy M.

PY - 2016

Y1 - 2016

N2 - 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).

AB - 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).

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