Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
Liver Int. 2016 Jan;36(1):92-9. doi: 10.1111/liv.12865. Epub 2015 May 31.
BACKGROUNDS & AIMS: We aimed to generate and validate a novel risk prediction model for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE).
Patients receiving TACE as the first-line therapy between 2006 and 2009 were selected from the databases of two major tertiary hospitals in Korea. This study population was randomly assigned into training (n = 340) and validation (n = 145) sets. From a multivariate Cox-regression model for overall survival (OS), tumour Size, tumour Number, baseline Alpha-foetoprotein level, Child-Pugh class and Objective radiological Response after the first TACE session were selected and then scored to generate a 10-point risk prediction model (named as "SNACOR" model) in the training set. Thereafter, the prognostic performance was assessed in the validation set.
In the training set, the time-dependent areas under receiver-operating characteristic curves (AUROCs) for OS at 1-, 3- and 6-years were 0.756, 0.754 and 0.742 respectively. According to the score of the SNACOR model, patients were stratified into three groups; low- (score 0-2), intermediate- (score 3-6) and high-risk group (score 7-10) respectively. The low-risk group had the longest median OS (49.8 months), followed by intermediate- (30.7 months) and high-risk group (12.4 months) (log-rank test, P < 0.001). Compared with the low-risk group, the intermediate-risk (hazard ratio [HR] 2.13, P < 0.001) and high-risk group (HR 6.17, P < 0.001) retained significant risks of death. Similar results were obtained in the validation set.
A simple-to-use SNACOR model for patients with HCC treated with TACE might be helpful in appropriate prognostification and guidance for decision of further treatment strategies.
我们旨在为接受经动脉化疗栓塞术（TACE）的肝细胞癌（HCC）患者生成并验证一种新的风险预测模型。
从韩国两家主要的三级医院的数据库中选择了 2006 年至 2009 年期间接受 TACE 作为一线治疗的患者。该研究人群被随机分配到训练集（n = 340）和验证集（n = 145）。从总生存（OS）的多变量 Cox 回归模型中，选择肿瘤大小、肿瘤数量、基线甲胎蛋白水平、Child-Pugh 分级和首次 TACE 后客观放射学反应，并对其进行评分，以生成训练集中的 10 分风险预测模型（命名为“SNACOR”模型）。随后，在验证集中评估该模型的预后性能。
在训练集中，OS 的时间依赖性受试者工作特征曲线（AUROCs）在 1、3 和 6 年时分别为 0.756、0.754 和 0.742。根据 SNACOR 模型的评分，患者被分为三组：低风险组（评分 0-2）、中风险组（评分 3-6）和高风险组（评分 7-10）。低风险组的中位 OS 最长（49.8 个月），其次是中风险组（30.7 个月）和高风险组（12.4 个月）（对数秩检验，P < 0.001）。与低风险组相比，中风险组（危险比[HR]2.13，P < 0.001）和高风险组（HR 6.17，P < 0.001）死亡风险显著增加。验证集也得到了类似的结果。
对于接受 TACE 治疗的 HCC 患者，一种简单易用的 SNACOR 模型可能有助于适当的预后判断和进一步治疗策略的决策。
