Background/Objectives: Intrahepatic cholangiocarcinoma (ICC) is subclassified into small and large duct types. Although these subclassifications may help determine the appropriate treatment strategy, subclassification diagnosis currently depends on postoperative pathological examinations. This study aimed to establish a nomogram to predict ICC subclassifications. Methods: This study included 126 patients with ICC who underwent liver resection. The participants were divided into small and large duct-type ICC groups. A nomogram to predict large duct-type ICC was developed using four diagnostic imaging findings: rim-type enhancement in the early phase, an absence of tumor enhancement in the early phase, the presence of peripheral biliary dilatation due to tumor invasion, the presence of penetrating Glisson’s vessels in the tumor, and two laboratory test results: serum gamma-glutamyl transpeptidase and carbohydrate antigen 19-9 levels. Nomogram performance was also assessed. Moreover, the bootstrap method and calibration plots were used to assess nomogram validity. Results: Seventy and fifty-six patients were pathologically diagnosed with small and large duct-type ICCs, respectively. The area under the curve of the established nomogram was 0.93 and remained 0.91 after Harrell’s bias correction. The sensitivity and specificity of the nomogram developed using the Youden index were higher than those of any of the characteristic imaging findings. Calibration plots demonstrated a strong association between the nomogram and the actual data. Conclusions: We developed a novel preoperative nomogram to predict large duct-type ICC. This nomogram can be clinically useful for predicting the subclassifications of ICCs and may contribute to the establishment of a more appropriate treatment strategy for ICC.
背景/目的：肝内胆管癌（ICC）可分为小胆管型与大胆管型。尽管这种亚型分类有助于确定合适的治疗策略，但目前亚型诊断主要依赖于术后病理检查。本研究旨在构建一个预测ICC亚型分类的列线图模型。方法：本研究纳入126例接受肝切除术的ICC患者，将其分为小胆管型与大胆管型ICC两组。基于四项影像学特征（动脉期边缘强化、动脉期肿瘤无强化、肿瘤侵犯导致周围胆管扩张、肿瘤内穿行Glisson系统血管）及两项实验室指标（血清γ-谷氨酰转移酶和糖类抗原19-9水平），构建了预测大胆管型ICC的列线图模型，并评估其预测效能。采用Bootstrap法和校准曲线验证模型有效性。结果：病理诊断显示70例为小胆管型ICC，56例为大胆管型ICC。所构建列线图的曲线下面积为0.93，经Harrell偏倚校正后仍达0.91。基于约登指数确定的列线图敏感度与特异度均高于任何单项影像学特征。校准曲线显示列线图预测值与实际观测值高度吻合。结论：本研究成功构建了新型术前预测大胆管型ICC的列线图模型。该模型在临床实践中可用于预测ICC亚型分类，有助于制定更精准的ICC治疗策略。
肿瘤(癌症)患者之家