Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

Objective To establish nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). Methods A cohort of 422 patients with HCC or ICC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent differential factors. Through combining these independent differential factors, a nomogram was established for differential diagnosis between ICC and HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The results were validated using a prospective study on 98 consecutive patients operated on from January 2019 to November 2019 at the same institution. Results Sex (OR = 9.001, 95% CI: 3.268-24.792, P < .001), hepatitis (OR = 0.323, 95% CI: 0.121-0.860, P = .024), alpha-fetoprotein (AFP) (OR = 0.997, 95% CI: 0.995-1.000, P = .046), carbohydrate antigen 19-9 (CA199) (OR = 1.016, 95% CI: 1.007-1.025, P < .001), and aspartate transaminase-to-neutrophil ratio index (ANRI) (OR = 0.904, 95% CI: 0.843-0.969, P = .004) were the independent differential factors for ICC. Nomogram was established with well-fitted calibration curves through incorporating these 5 factors. Comparing model 1 including gender, hepatitis, AFP, and CA199 (C index = 0.903, 95% CI: 0.849-0.957) and model 2 enrolling AFP and CA199 (C index = 0.850, 95% CI: 0.791-0.908), the nomogram showed a better discrimination between ICC and HCC, with a C index of 0.920 (95% CI, 0.872-0.968). The results were consistent in the validation cohort. DCA also confirmed the conclusion. Conclusion A nomogram was established for the differential diagnosis between ICC and HCC preoperatively, and better therapeutic choice would be made if it was applied in clinical practice.