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Objective To establish and validate a Nomogram model for predicting the overall survival (OS) of the patients with intrahepatic cholangiocarcinoma (ICC) based on domestic multicenter data, and screen the beneficiaries of adjuvant chemotherapy based on the prediction model. Methods From December 2011 to December 2017, the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model. This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy. Results A total of 278 patients were enrolled, and 23 cases(8.3%) received adjuvant chemotherapy. COX multivariate analysis showed that drinking history, ECOG score, method of hepatectomy, lymph node status, number of tumors, and tumor differentiation were independent risk factors for postoperative OS. The Nomogram model had a C-index of 0.690(95% CI: 0.646-0.734) in the training cohort and 0.740(95% CI: 0.863-0.617) in the validation cohort. According to risk stratification by Nomogram model, in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy (P=0.033), whereas in the low-risk group, there was no significant difference in survival(P=0.59). Conclusion Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen, and identify the patients with ICC who benefit from adjuvant chemotherapy.

Objective To investigate the effectiveness of pulse pressure variability (PPV) measured by continuous non-invasive arterial pressure (CNAP) monitor in guidance of fluid resuscitation in postoperative hypovolemic patients. Methods A prospective randomized controlled trial was conducted on the postoperative hypovolemic patients admitted to Department of Intensive Care Unit of Fujian Provincial Hospital from August 2018 to August 2020. They were randomly divided into PPV group and central venous pressure (CVP) group, and fluid resuscitation targeted by PPV < 10% (measured by CNAP) and CVP 8~12 mmHg were performed respectively. The main outcomes included fluid resuscitation time, duration of mechanical ventilation, cumulative fluid balance and incidence of cardiopulmonary complications. The secondary outcomes included hemodynamics [heart rate (HR), mean arterial pressure (MAP), CVP, cardiac index (CI), and PPV] and tissue oxygen metabolism [central venous oxygen saturation (ScvO2), arterial lactic acid (Lac), oxygen delivery index (DO2I), oxygen consumption index (VO2I), and oxygen uptake rate (ERO2)] as the goal of fluid resuscitation was arrived. Results A total of 78 patients were enrolled, including 38 in PPV group and 40 in CVP group. There were no significant differences in the baseline, hemodynamic and tissue oxygen metabolism parameters between the 2 groups (all P>0.05). The hemodynamic and tissue oxygen metabolism parameters were significantly improved as the goal of fluid resuscitation was arrived. No significant differences were seen in MAP, CI and PPV between the 2 groups after fluid resuscitation (all P>0.05), while CVP in the PPV group was significantly lower than that of the CVP group (P < 0.05). Compared with the CVP group, the ScvO2, DO2I, VO2I and ERO2 were increased significantly after fluid resuscitation in the PPV group (all P < 0.05), while Lac was decreased obviously in the PPV group (P < 0.05). Furthermore, the fluid resuscitation time and duration of mechanical ventilation were notably shortened, the cumulative fluid balance was remarkably decreased, and the incidence of cardiopulmonary complications was statistically reduced in the PPV group than the CVP group (all P < 0.05). Conclusion PPV measured by CNAP monitor can be used to guide the early fluid resuscitation in postoperative hypovolemic patients, which contributes to stabilizing the hemodynamic state more timely, improving the tissue oxygen metabolism, shortening the duration of mechanical ventilation, and reducing the risk of cardiopulmonary complications.

The prognosis of Intrahepatic cholangiocarcinoma (ICC) patients who did not undergo lymphadenectomy is difficult to assess. This study aims to have a dynamic evaluation on the postoperative survival of ICC patients by calculating conditional survival. Relevant data were from patients treated in 12 large-scale hospitals from December 2011 to December 2017. The influence of relevant clinical baseline data on the prognosis of ICC patients was analyzed by Cox regression. Conditional survival (CS) is a method that may predict the prognostic probability dynamically. For a patient with x years of survival, the 1-year CS (CS1) may be calculated as CS1= OS(x + 1)/OS(x). A total of 361 patients who met the criteria were included in the study. Conditional survival (CS) means that the patients' prognosis varies with survival time, meanwhile, relevant factors affecting the prognosis have a time-varying effect. The probability of survival assessed by CS1 increased year by year and the 1,2,3-year survival improved from 68.4% to 87.8%, while the postoperative actuarial OS decreased from 69.4% at 1 years to 36.9% at 3 years. In terms of CS, the estimated survival for ICC varies with the increase of survival time after excision. Patients who live longer were likely to live longer. At the same time, with the passage of time, the role of the original adverse factors of the tumor would gradually decrease. Conditional survival allows a more accurate assessment of ICC patients who did not undergo lymphadenectomy. [ABSTRACT FROM AUTHOR]