尽管切除手术仍然是治疗肝门部胆管癌（PHC）的唯一根治方法，但众所周知这种手术与高发病率和死亡率的风险相关。然而，除了面临威胁生命的并发症外，患者还可能出现早期疾病复发，将PHC手术定义为“徒劳”。本研究的目的是预测高风险类别（徒劳组），在该组中手术的益处逆转，可以考虑替代治疗。研究队列包括来自27个西方三级转诊中心的预先维护的数据：人群分为开发队列和验证队列。使用弗雷明翰心脏研究方法开发了一种术前评分系统，预测“徒劳”结果。共分析了2271例病例：其中，309例被分类为“徒劳组”（13.6%）。ASA评分≥3（OR 1.60；p = 0.005），诊断时的胆红素≥ 50 mmol/L（OR 1.50；p = 0.025），Ca 19-9 ≥ 100 U/mL（OR 1.73；p = 0.013），术前胆道炎（OR 1.75；p = 0.002），门静脉侵犯（OR 1.61；p = 0.020），肿瘤直径≥3 cm（OR 1.76；p < 0.001）和左侧切除（OR 2.00；p < 0.001）被确定为自主预测的徒劳因素。开发的评分系统将患者分为三个风险等级（低、中、高），在验证队列上测试时显示出良好的准确性（AUC 0.755）。能够通过评分系统精确估计术后严重发病率和早期复发的风险，可以根据术前特征来确定最佳管理策略（手术 vs. 非手术治疗）。版权所有 © 2023美国肝病学会。

Whilst resection remains the only curative option for perihilar cholangiocarcinoma (PHC), it is well known that such surgery is associated with a high risk of morbidity and mortality. Nevertheless, beyond facing life-threatening complications, patients may also develop early disease recurrence, defining a "futile" outcome in PHC surgery. The aim of this study is to predict the high-risk category (futile group) where surgical benefits are reversed and alternative treatments may be considered.The study cohort included prospectively maintained data from 27 Western tertiary referral centers: the population was divided in a development and a validation cohort. The Framingham Heart Study methodology was used to develop a preoperative scoring system predicting the "futile" outcome.A total of 2271 cases were analysed: among them, 309 were classified within the "futile group" (13.6%). ASA score ≥ 3 (OR 1.60; p = 0.005), bilirubin at diagnosis ≥ 50 mmol/L (OR 1.50; p = 0.025), Ca 19-9 ≥ 100 U/mL (OR 1.73; p = 0.013), preoperative cholangitis (OR 1.75; p = 0.002), portal vein involvement (OR 1.61; p = 0.020), tumor diameter ≥ 3 cm (OR 1.76; p < 0.001) and left sided resection (OR 2.00; p < 0.001) were identified as independent predictors of futility. The point system developed, defined three (i.e., low, intermediate, and high) risk classes, which showed good accuracy (AUC 0.755) when tested on the validation cohort.The possibility to accurately estimate, through a point system, the risk of severe postoperative morbidity and early recurrence, could be helpful in defining the best management strategy (surgery vs. non-surgical treatments) according to preoperative features.Copyright © 2023 American Association for the Study of Liver Diseases.