State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Hepatobiliary Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Clin Gastroenterol Hepatol. 2018 May;16(5):756-764.e10. doi: 10.1016/j.cgh.2017.12.002. Epub 2017 Dec 12.
BACKGROUND & AIMS: We aimed to establish and validate a nomogram to predict survival at 2 and 5 years after recurrence of hepatocellular carcinoma (HCC) in patients who have undergone curative resection.
We developed a nomogram using data from a training cohort of 638 patients (most with hepatitis B virus infection) with recurrence of HCC after curative resection at Sun Yat-sen University Cancer Center, in Guangzhou, China from 2007 through 2013. The median follow-up time was 39.7 months. Patients were evaluated every 3-4 months for the first 2 years after resection and every 3-6 months thereafter. The nomogram was based on variables independently associated with survival after HCC recurrence, including antiviral treatment; albumin-bilirubin grade and alpha-fetoprotein level at recurrence; time from primary resection to recurrence; size, site, number of recurrences; and treatment for recurrence. We validated the nomogram using data from an independent internal cohort of 213 patients treated at the same institution and an external cohort of 127 patients treated at 2 other centers in China, from 2002 through 2009. The predictive accuracy of the nomogram was measured using Harrell's concordance index (C index) and compared with the Barcelona Clinic Liver Cancer staging system of recurrence.
Our nomogram predicted survival of patients in the training cohort with a C-index of 0.797 (95% CI, 0.765-0.830)-greater than that of the Barcelona Clinic Liver Cancer staging system for recurrence (C-index score, 0.713; 95% CI, 0.680-0.745) (P < .001). This nomogram accurately stratified patients into subgroups with predicted long, medium, and short survival times: the proportions of patients in each group who survived 2 years after HCC recurrence were 91.2%, 67.6%, and 23.8%; the proportions of patients in each group who survived 5 years after HCC recurrence were 74.9%, 53.3%, and 9.1%. Our nomogram predicted patient survival times with C-index scores of 0.756 (95% CI, 0.703-0.808) in the internal validation cohort and 0.747 (95% CI, 0.701-0.794) in the external validation cohorts.
We developed a nomogram to determine the probability of survival, at different time points, of patients with recurrence of HCC (most with hepatitis B virus infection), after curative resection and validated it internally and externally.
本研究旨在建立并验证一个列线图模型，以预测接受根治性切除术的肝癌（HCC）患者复发后 2 年和 5 年的生存情况。
我们开发了一个列线图模型，该模型基于中山大学肿瘤防治中心（位于中国广州）2007 年至 2013 年间接受根治性切除术且复发的 638 例患者（大多数患有乙型肝炎病毒感染）的数据。中位随访时间为 39.7 个月。患者在切除术后的前 2 年内每 3-4 个月评估一次，此后每 3-6 个月评估一次。该列线图基于与 HCC 复发后生存相关的独立变量，包括抗病毒治疗；复发时的白蛋白-胆红素分级和甲胎蛋白水平；从原发性切除术到复发的时间；肿瘤大小、部位、复发次数；以及对复发的治疗。我们使用同一机构的 213 例患者的独立内部队列和 2002 年至 2009 年在中国的另外 2 个中心治疗的 127 例患者的外部队列数据对该列线图进行了验证。该列线图的预测准确性通过 Harrell 的一致性指数（C 指数）进行衡量，并与巴塞罗那临床肝癌复发分期系统进行了比较。
我们的列线图预测了训练队列中患者的生存情况，其 C 指数为 0.797（95%CI，0.765-0.830）-高于巴塞罗那临床肝癌复发分期系统的 C 指数（0.713；95%CI，0.680-0.745）（P<.001）。该列线图能够准确地将患者分为具有预测长、中、短生存时间的亚组：每组中在 HCC 复发后 2 年存活的患者比例分别为 91.2%、67.6%和 23.8%；每组中在 HCC 复发后 5 年存活的患者比例分别为 74.9%、53.3%和 9.1%。我们的列线图在内部验证队列中预测患者生存时间的 C 指数为 0.756（95%CI，0.703-0.808），在外部验证队列中预测患者生存时间的 C 指数为 0.747（95%CI，0.701-0.794）。
我们开发了一个列线图来确定接受根治性切除术且复发的 HCC（大多数患有乙型肝炎病毒感染）患者在不同时间点的生存概率，并在内部和外部进行了验证。
