Diffuse reduction of spleen density is a novel prognostic marker for intrahepatic cholangiocarcinoma after curative resection

Figure 1 Flow diagram showings study inclusion and exclusion criteria. CT: Computed tomography; ICC: Intrahepatic cholangiocarcinoma.

Figure 2 Spleen density of intrahepatic cholangiocarcinoma patients. A-C: Mean spleen density at the upper pole level (A), hilum level (B), and inferior pole level (C) on computed tomography; D: Optimal cut-off level of spleen density that stratified patients into diffuse reduction of spleen density (DROSD) and non-DROSD subgroups was 45.5 Hounsfield units.

Figure 3 Kaplan–Meier curves of overall survival and recurrence-free survival comparisons between patients with and without diffuse reduction of spleen density in the cohort. A: Overall survival; B: Recurrence-free survival. DROSD: Diffuse reduction of spleen density.

Figure 4 Forest plot for univariable and multivariable Cox regression analysis of overall survival. A: Univariable analysis: the indicators marked in red and green are significant at P < 0.05 and then included in the multivariable analysis; B: Multivariable analyses: the indicators marked in red are significant at P < 0.05. AFP: Alpha-fetoprotein; ASA: American Society of Anesthesiologists grade score; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CI: Confidence interval; DROSD: Diffuse reduction of spleen density; HR: Hazard ratio; LMR: Lymphocyte/monocyte ratio; NLR: Neutrophil/lymphocyte ratio; OS: Overall survival; PCs: Postoperative complications; PLR: Platelet/lymphocyte ratio.

Figure 5 Forest plot for univariable and multivariable Cox regression analysis of recurrence-free survival. A: Univariable analysis: the indicators marked in red and green are significant at P < 0.05 and then included in the multivariable analysis; B: Multivariable analysis: The indicators marked in red are significant at P < 0.05. AFP: Alpha-fetoprotein; ASA: American Society of Anesthesiologists grade score; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CI: Confidence interval; DROSD: Diffuse reduction of spleen density; HR: Hazard ratio; LMR: Lymphocyte/monocyte ratio; NLR: Neutrophil/lymphocyte ratio; PCs: Postoperative complications; PLR: Platelet/lymphocyte ratio; RFS: Recurrence-free survival.

Figure 6 A nomogram predicts the overall survival of patients with intrahepatic cholangiocarcinoma. A: The nomogram predicted 1-, 3- and 5-year overall survival (OS) for intrahepatic cholangiocarcinoma (ICC) patients; B: The calibration plots showed excellent agreement between observed outcomes and predicted survival probabilities; C: The area under the receiver operating characteristic curve of OS. CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; PCs: Postoperative complications.