Abstract Objective To identify prognostic factors and develop a predictive tool for patients with hilar cholangiocarcinoma (HCCA) undergoing R1 or R2 resection, thereby informing patient selection and individualized treatment decisions. Methods A retrospective analysis was conducted of HCCA patients who underwent R1 or R2 resection at a single center. Independent prognostic factors were identified using Cox regression analysis, and a predictive nomogram was constructed using R software. Results Multivariate analysis identified four independent prognostic factors: surgical margin status ( P = 0.002), tumor differentiation grade ( P = 0.030), vascular invasion ( P < 0.001), and adjuvant therapy ( P = 0.023). The nomogram based on these factors demonstrated favorable discriminatory ability, with a C-index of 0.780. Time-dependent receiver operating characteristic (ROC) analysis yielded areas under the curve (AUC) of 0.904 (95% confidence interval CI: 0.831–0.966) and 0.822 (95% CI: 0.736–0.897) for predicting 1-year and 2-year survival, respectively. Patients stratified into high-risk and low-risk groups by the nomogram showed significantly different survival outcomes (1-year survival: 44% vs. 92.5%; 2-year survival: 20% vs. 52.8%). Conclusion The developed nomogram effectively predicts prognosis following R1 or R2 resection for HCCA, demonstrating good discrimination and short-term predictive accuracy. It serves as a useful tool for postoperative risk stratification and personalized management planning.
Wang et al. (Wed,) studied this question.