The VITAL prognostic model for cHCC-CCA after surgery: Integrating viral, inflammatory, tumor biology, and anatomic lesion

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare and heterogeneous primary liver malignancy with poor outcomes after resection. This study aimed to develop and preliminarily validate postoperative prognostic models incorporating clinical, pathological, and inflammatory variables. PATIENTS AND METHODS: We retrospectively analyzed 182 patients with pathologically confirmed cHCC-CCA who underwent curative-intent hepatectomy at two centers, including 145 patients in the training cohort and 37 in the external validation cohort. LASSO regression and multivariable Cox regression were used to identify predictors of overall survival (OS) and disease-free survival (DFS). RESULTS: Independent predictors of OS were HBV status, tumor differentiation, tumor diameter, HCC AJCC stage, and neutrophil-to-lymphocyte ratio. Independent predictors of DFS were HBV status, MVI, tumor diameter, AFP and monocyte-to-lymphocyte ratio. These factors collectively span the four VITAL dimensions. The VITAL nomograms outperformed conventional HCC and ICC staging systems in both cohorts and effectively stratified patients by risk. CONCLUSIONS: The VITAL nomogram integrates viral, inflammatory, tumor biological, and anatomical dimensions into a single instrument, providing superior postoperative risk stratification compared with conventional staging in cHCC-CCA. Further multicenter validation is warranted.