Preoperative prediction of textbook outcome in intrahepatic cholangiocarcinoma by interpretable machine learning: A multicenter cohort study

Table 1 Baseline characteristics of patients in training group, n (%)

Variables	Total (n = 287)	Textbook outcome (n = 150)	None-textbook outcome (n = 137)	P value
Age, M (Q1, Q3)	56.00 (48.00, 63.00)	55.00 (47.00, 62.00)	59.00 (49.00, 63.00)	0.118
Sex				0.011
Male	189 (65.85)	109 (72.67)	80 (58.39)
Female	98 (34.15)	41 (27.33)	57 (41.61)
Hepatitis B				0.002
Negative	179 (62.37)	81 (54.00)	98 (71.53)
Positive	108 (37.63)	69 (46.00)	39 (28.47)
ECOG score				0.026
0	85 (29.62)	53 (35.33)	32 (23.36)
1	202 (70.38)	97 (64.67)	105 (76.64)
Child Pugh				0.005
A	175 (60.98)	80 (53.33)	95 (69.34)
B	112 (39.02)	70 (46.67)	42 (30.66)
Tumor size, M (Q1, Q3)	6.40 (4.65, 8.90)	6.10 (4.30, 8.40)	7.00 (5.00, 9.20)	0.098
Tumor number				0.870
Solitary	192 (66.90)	101 (67.33)	91 (66.42)
Multiple	95 (33.10)	49 (32.67)	46 (33.58)
TBIL, M (Q1, Q3)	20.00 (12.95, 31.90)	22.90 (14.50, 32.90)	17.10 (11.20, 28.10)	0.013
DBIL, M (Q1, Q3)	7.90 (4.60, 14.75)	8.85 (5.30, 15.45)	7.30 (3.50, 14.40)	0.012
CA19-9, M (Q1, Q3)	17.30 (8.95, 34.20)	20.90 (13.90, 33.55)	11.50 (3.90, 37.30)	< 0.001
AFP, M (Q1, Q3)	12.70 (3.30, 171.50)	29.10 (3.62, 314.50)	7.40 (3.20, 78.20)	0.065
CEA, M (Q1, Q3)	2.60 (1.60, 4.10)	2.45 (1.50, 4.00)	2.60 (1.60, 4.60)	0.219
Blood transfusion				< 0.001
No	247 (86.06)	150 (100.00)	97 (70.80)
Yes	40 (13.94)	0 (0.00)	40 (29.20)
Surgical margins				< 0.001
Negative	276 (96.17)	150 (100.00)	126 (91.97)
Positive	11 (3.83)	0 (0.00)	11 (8.03)
Complications				< 0.001
No	227 (79.09)	150 (100.00)	77 (56.20)
Yes	60 (20.91)	0 (0.00)	60 (43.80)
Perioperative death or readmission within 30 days after discharge				0.008
No	279 (97.21)	150 (100.00)	129 (94.16)
Yes	8 (2.79)	0 (0.00)	8 (5.84)
Prolonged hospitalization				< 0.001
No	187 (65.16)	150 (100.00)	37 (27.01)
Yes	100 (34.84)	0 (0.00)	100 (72.99)

M: Median; Q₁: 1^st quartile, Q₃: 3^st quartile; ECOG score: Eastern Cooperative Oncology Group score; TBIL: Total bilirubin; DBIL: Direct bilirubin; CA19-9: Carbohydrate antigen 19-9; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen.

Table 2 Baseline characteristics of patients in validation group, n (%)

Variables	Total (n = 89)	Textbook outcome (n = 49)	None-textbook outcome (n = 40)	P value
Age, M (Q1, Q3)	58.00 (48.00, 65.00)	59.00 (53.00, 64.00)	56.50 (46.75, 65.00)	0.501
Sex				0.167
Male	53 (59.55)	26 (53.06)	27 (67.50)
Female	36 (40.45)	23 (46.94)	13 (32.50)
Hepatitis B				0.190
Negative	64 (71.91)	38 (77.55)	26 (65.00)
Positive	25 (28.09)	11 (22.45)	14 (35.00)
ECOG score				0.001
0	32 (35.96)	25 (51.02)	7 (17.50)
1	57 (64.04)	24 (48.98)	33 (82.50)
Child-Pugh				0.017
A	57 (64.04)	26 (53.06)	31 (77.50)
B	32 (35.96)	23 (46.94)	9 (22.50)
Tumor size, M (Q1, Q3)	6.50 (5.00, 8.40)	6.70 (4.70, 8.40)	6.50 (5.00, 8.27)	0.853
Tumor number				0.104
Solitary	66 (74.16)	33 (67.35)	33 (82.50)
Multiple	23 (25.84)	16 (32.65)	7 (17.50)
TBIL, M (Q1, Q3)	17.20 (10.70, 33.10)	19.00 (10.60, 41.50)	16.00 (11.18, 28.75)	0.668
DBIL, M (Q1, Q3)	7.90 (4.60, 12.70)	8.90 (5.10, 12.70)	6.45 (4.33, 12.25)	0.203
CA19-9, M (Q1, Q3)	109.10 (13.90, 778.00)	192.70 (17.60, 1000.00)	83.95 (8.10, 485.52)	0.073
AFP, M (Q1, Q3)	6.20 (2.70, 97.60)	5.10 (2.40, 97.60)	6.95 (2.70, 74.53)	0.738
CEA, M (Q1, Q3)	2.70 (1.80, 4.79)	2.50 (1.70, 3.70)	3.10 (2.00, 10.67)	0.030
Blood transfusion				0.008
No	82 (92.13)	49 (100.00)	33 (82.50)
Yes	7 (7.87)	0 (0.00)	7 (17.50)
Surgical margins				0.008
Negative	82 (92.13)	49 (100.00)	33 (82.50)
Positive	7 (7.87)	0 (0.00)	7 (17.50)
Complications				< 0.001
No	70 (78.65)	49 (100.00)	21 (52.50)
Yes	19 (21.35)	0 (0.00)	19 (47.50)
Perioperative death or readmission within 30 days after discharge				0.08
No	85 (95.51)	48 (100.00)	37 (90.00)
Yes	4 (4.49)	0 (0.00)	4 (10.00)
Prolonged hospitalization				< 0.001
No	57 (64.04)	49 (100.00)	8 (20.00)
Yes	32 (35.96)	0 (0.00)	32 (80.00)

M: Median; Q₁: 1^st quartile; Q₃: 3^st quartile; ECOG score: Eastern Cooperative Oncology Group score; TBIL: Total bilirubin; DBIL: Direct bilirubin; CA19-9: Carbohydrate antigen 19-9; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen.

Table 3 Influencing factors of textbook outcome

Characteristics	OR	95%CI	P value	OR1	95%CI1	P value1
Female	1.89	1.16-3.11	0.011	1.59	0.95-2.69	0.08
Age	1.01	0.99-1.03	0.41	NA	NA	NA
Hepatitis B	0.47	0.29-0.76	0.002	0.58	0.35-0.98	0.041
Child-Pugh A	0.51	0.31-0.82	0.006	0.5	0.3-0.83	0.007
ECOG score = 1	1.79	1.07-3.01	0.027	1.9	1.1-3.28	0.022
Tumor size	1.08	1.01-1.17	0.032	1.09	1.01-1.18	0.036
Multiple tumor	1.04	0.64-1.7	0.87	NA	NA	NA
AFP level	1	1-1	0.486	NA	NA	NA
CA19-9 level	1	1-1	0.544	NA	NA	NA
CEA level	1	1-1	0.656	NA	NA	NA
TBIL level	1	0.99-1	0.228	NA	NA	NA
DBIL level	1	0.99-1	0.262	NA	NA	NA

¹The results of multifactor logistic regression.

OR: Odds ratio; ECOG score: Eastern Cooperative Oncology Group score; TBIL: Total bilirubin; DBIL: Direct bilirubin; CA19-9: Carbohydrate antigen 19-9; AFP: Alpha-fetoprotein; CEA: Carcinoembryonic antigen; NA: Not available.