Development and external validation of a prediction model for overall survival after resection of distal cholangiocarcinoma

Ali Belkouz, Stijn Van Roessel, Marin Strijker, Jacob L van Dam, Lois Daamen, Lydia G van der Geest, Alberto Balduzzi, Andrea Benedetti Cacciaguerra, Susan van Dieren, Quintus Molenaar, Bas Groot Koerkamp, Joanne Verheij, Elizabeth Van Eycken, Giuseppe Malleo, Mohammed Abu Hilal, Martijn G H van Oijen, Ivan Borbath, Chris Verslype, Cornelis J A Punt, Marc G BesselinkHeinz-Josef Klümpen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


BACKGROUND: Various prognostic factors are associated with overall survival (OS) after resection of distal cholangiocarcinoma (dCCA). The objective of this study was to develop and validate a prediction model for 3-year OS after pancreatoduodenectomy for dCCA.

METHODS: The derivation cohort consisted of all patients who underwent pancreatoduodenectomy for dCCA in the Netherlands (2009-2016). Clinically relevant variables were selected based on the Akaike information criterion using a multivariate Cox proportional hazards regression model, with model performance being assessed by concordance index (C-index) and calibration plots. External validation was performed using patients from the Belgium Cancer Registry (2008-2016), and patients from two university hospitals of Southampton (U.K.) and Verona (Italy).

RESULTS: Independent prognostic factors for OS in the derivation cohort of 454 patients after pancreatoduodenectomy for dCCA were age (HR 1.02, 95% CI 1.01-1.03), pT (HR 1.43, 95% CI 1.07-1.90) and pN category (pN1: HR 1.78, 95% CI 1.37-2.32; pN2: HR 2.21, 95% CI 1.63-3.01), resection margin status (HR 1.79, 95% CI 1.39-2.29) and tumour differentiation (HR 2.02, 95% CI 1.62-2.53). The prediction model was based on these prognostic factors. The optimism-adjusted C-indices were similar in the derivation cohort (0.69), and in the Belgian (0.66) and Southampton-Verona (0.68) validation cohorts. Calibration was accurate in the Belgian validation cohort (slope = 0.93, intercept = 0.12), but slightly less optimal in the Southampton-Verona validation cohort (slope = 0.88, intercept = 0.32). Based on this model, three risk groups with different prognoses were identified (3-year OS of 65.4%, 33.2% and 11.8%).

CONCLUSIONS: The prediction model for 3-year OS after resection of dCCA had reasonable performance in both the derivation and geographically external validation cohort. Calibration slightly differed between validation cohorts. The model is readily available via www. to inform patients from Western European countries on their prognosis, and may be used to stratify patients for clinical trials.

Original languageEnglish
Pages (from-to)1280-1288
Number of pages9
JournalBritish Journal of Cancer
Issue number9
Early online dateJan 2022
Publication statusPublished - 18 May 2022

Bibliographical note

Funding Information:
This study was conducted on behalf of the Dutch Pancreatic Cancer Group (DPCG).

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.


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