Notake Tsuyoshi, Kobayashi Akira, Shinkawa Hiroji, Kawahara Takuya, Shimizu Akira, Yokoyama Takahide, Hasegawa Kiyoshi, Kokudo Norihiro, Matsuyama Yutaka, Makuuchi Masatoshi, Miyagawa Shin-Ichi
Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Int J Clin Oncol. 2017 Aug;22(4):715-725. doi: 10.1007/s10147-017-1114-1. Epub 2017 Mar 16.
The aim of this study was to construct and validate a nomogram for predicting survival after the intrahepatic recurrence of hepatocellular carcinoma (HCC) following an initial hepatectomy.
A primary cohort of 268 patients who underwent curative hepatectomy for HCC at Shinshu University Hospital between 1990 and 2010 was retrospectively studied. A nomogram was constructed based on independent prognostic factors for overall survival after recurrence. The predictive performance was evaluated using the concordance index (c-index) and a calibration curve. The nomogram was then externally validated in a cohort of patients from Tokyo University Hospital (n = 296).
In multivariate analysis, the following 5 variables were identified as independent predictors of overall survival and incorporated into the nomogram-Japan Integrated Stage score at initial liver resection, platelet count at initial liver resection, time until intrahepatic recurrence, vascular invasion at recurrence, and type of treatment used for intrahepatic recurrence. The nomogram had a c-index of 0.75 (95% confidence interval 0.60-0.85) for the Shinshu cohort and 0.71 (0.57-0.81) for the Tokyo cohort. The predicted 3- and 5-year survival probabilities corresponded well with the actual outcomes.
The established nomogram might be useful for estimating survival after the intrahepatic recurrence of HCC.
本研究旨在构建并验证一种列线图，用于预测肝细胞癌（HCC）初次肝切除术后肝内复发的生存率。
回顾性研究了1990年至2010年间在信州大学医院接受根治性肝切除术治疗HCC的268例患者的原始队列。基于复发后总生存的独立预后因素构建列线图。使用一致性指数（c指数）和校准曲线评估预测性能。然后在东京大学医院的一组患者（n = 296）中对列线图进行外部验证。
在多变量分析中，以下5个变量被确定为总生存的独立预测因素，并纳入列线图——初次肝切除时的日本综合分期评分、初次肝切除时的血小板计数、肝内复发时间、复发时的血管侵犯以及肝内复发所用的治疗类型。信州队列的列线图c指数为0.75（95%置信区间0.60 - 0.85），东京队列的c指数为0.71（0.57 - 0.81）。预测的3年和5年生存概率与实际结果吻合良好。
所建立的列线图可能有助于估计HCC肝内复发后的生存率。
