Ang Soo Fan, Ng Elizabeth Shu-Hui, Li Huihua, Ong Yu-Han, Choo Su Pin, Ngeow Joanne, Toh Han Chong, Lim Kiat Hon, Yap Hao Yun, Tan Chee Kiat, Ooi London Lucien Peng Jin, Cheow Peng Chung, Chung Alexander Yaw Fui, Chow Pierce Kah Hoe, Foo Kian Fong, Tan Min-Han
Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore.
Health Services Research, Singapore General Hospital, Singapore, Republic of Singapore; Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Republic of Singapore.
PLoS One. 2015 Apr 1;10(4):e0118658. doi: 10.1371/journal.pone.0118658. eCollection 2015.
Surgery is the primary curative option in patients with hepatocellular carcinoma (HCC). Current prognostic models for HCC are developed on datasets of primarily patients with advanced cancer, and may be less relevant to resectable HCC. We developed a postoperative nomogram, the Singapore Liver Cancer Recurrence (SLICER) Score, to predict outcomes of HCC patients who have undergone surgical resection.
Records for 544 consecutive patients undergoing first-line curative surgery for HCC in one institution from 1992-2007 were reviewed, with 405 local patients selected for analysis. Freedom from relapse (FFR) was the primary outcome measure. An outcome-blinded modeling strategy including clustering, data reduction and transformation was used. We compared the performance of SLICER in estimating FFR with other HCC prognostic models using concordance-indices and likelihood analysis.
A nomogram predicting FFR was developed, incorporating non-neoplastic liver cirrhosis, multifocality, preoperative alpha-fetoprotein level, Child-Pugh score, vascular invasion, tumor size, surgical margin and symptoms at presentation. Our nomogram outperformed other HCC prognostic models in predicting FFR by means of log-likelihood ratio statistics with good calibration demonstrated at 3 and 5 years post-resection and a concordance index of 0.69. Using decision curve analysis, SLICER also demonstrated superior net benefit at higher threshold probabilities.
The SLICER score enables well-calibrated individualized predictions of relapse following curative HCC resection, and may represent a novel tool for biomarker research and individual counseling.
手术是肝细胞癌（HCC）患者的主要治愈选择。目前的HCC预后模型是基于主要为晚期癌症患者的数据集开发的，可能与可切除的HCC相关性较小。我们开发了一种术后列线图，即新加坡肝癌复发（SLICER）评分，以预测接受手术切除的HCC患者的预后。
回顾了1992年至2007年在一家机构接受一线HCC根治性手术的544例连续患者的记录，选择405例本地患者进行分析。无复发生存期（FFR）是主要的预后指标。采用了包括聚类、数据降维和转换在内的结果盲法建模策略。我们使用一致性指数和似然分析比较了SLICER在估计FFR方面与其他HCC预后模型的性能。
开发了一种预测FFR的列线图，纳入了非肿瘤性肝硬化、多灶性、术前甲胎蛋白水平、Child-Pugh评分、血管侵犯、肿瘤大小、手术切缘和就诊时症状。我们的列线图在通过对数似然比统计预测FFR方面优于其他HCC预后模型，在切除后3年和5年显示出良好的校准，一致性指数为0.69。使用决策曲线分析，SLICER在较高阈值概率下也显示出更高的净效益。
SLICER评分能够对HCC根治性切除后的复发进行校准良好的个体化预测，可能代表了一种用于生物标志物研究和个体咨询的新工具。
