Textbook Outcome Nomograms as Multivariate Clinical Tools for Building Cancer Treatment Pathways and Prognosticating Outcomes

Menée à partir des données de 15 centres hépatobiliaires majeurs portant sur 687 patients atteints d'un cholangiocarcinome intra-hépatique traité par résection à visée curative entre 1993 et 2015 (âge médian : 61 ans), cette étude internationale évalue la proportion de patients pour lesquels les objectifs de qualité et de performance ont été atteints (absence de marges de résection positives, de transfusion sanguine, de complications post-opératoires, de prolongation de la durée d'hospitalisation, ...), puis identifie les facteurs clinico-pathologiques associés

Résumé en anglais

This form of thorough analysis is only possible for a rare disease such as cholangiocarcinoma through pooled data from many centers. The structure of a 15-center consortium from North America, Europe, and Asia in this study should be emulated. As electronic health records become more universal, it would be wonderful if data from even larger networks can be captured, analyzed, and used for quality assurance, individualized care planning, and selection of patients for clinical trials.Having a nomogram for assessing TO is also very useful in practice. It can be used to help select an individual patient’s programs of adjuvant therapy and surveillance through clinical pathways. Further, such nomograms may assist in decisions for preoperative cancer care. If relieving jaundice or shrinking tumors prior to surgery can be correlated with an increase in TO and better long-term outcomes, then nomograms may help drive neoadjuvant care. Such nomograms would also help clinicians communicate with patients about outcomes. Just as the National Surgical Quality Improvement Program calculator now allows better assessment and communications of perioperative complications and mortality, the TO nomogram may allow clinicians to discuss cancer-associated outcomes with patients.