Wiggers et al reported a preoperative score for identifying a patient with perihilar cholangiocarcinoma who has locally advanced or metastatic disease. The authors are from Academic Medical Center and Erasmus Medical Center in the Netherlands.
Patient selection: perihilar cholangiocarcinoma that appears to be resectable on imaging studies
Outcomes: locally advanced or metastatic
Preoperative parameters:
(1) serum total bilirubin in mg/dL
(2) Bismuth classification on imaging studies
(3) portal vein involvement on imaging studies
(4) hepatic artery involvement on imaging studies
(5) suspicious lymph nodes on imaging studies
Parameters
Findings
Points
serum total bilirubin
<= 2 mg/dL
0
> 2 mg/dL
1
Bismuth classification
left or right hepatic duct only
0
B1
2
B2, 3A or 3B
3
B4
4
portal vein involvement
none
0
unilateral
0
bilateral or main stem
3
hepatic artery involvement
none
0
unilateral
1
bilateral or main stem
6
suspicious lymph nodes
no
0
N1
1
N2
2
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the greater the risk of a poor outcome.
Score
Risk Group
Locally Advanced or Metastatic
0 to 3
low
15%
4
intermediate
30%
5 or 6
high
47%
7 to 16
very high
81%
Performance:
• The area under the ROC curve is 0.75.
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