Tian Meng-Xin, Luo Liu-Ping, Liu Wei-Ren, Deng Wei, Yin Jia-Cheng, Jin Lei, Jiang Xi-Fei, Zhou Yu-Fu, Qu Wei-Feng, Tang Zheng, Wang Han, Tao Chen-Yang, Fang Yuan, Qiu Shuang-Jian, Zhou Jian, Liu Jing-Feng, Fan Jia, Shi Ying-Hong
Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, People's Republic of China.
Cancer Manag Res. 2019 Jun 5;11:5187-5195. doi: 10.2147/CMAR.S195964. eCollection 2019.
To develop and validate a decision aid to help make individualized estimates of tumor recurrence for patients with resected combined hepatocellular cholangiocarcinoma (CHC). Risk factors of recurrence were identified in the derivation cohort of 208 patients who underwent liver resection between 1995 and 2014 at Zhongshan Hospital to develop a prediction score. The model was subsequently validated in an external cohort of 101 CHC patients using the C concordance statistic and net reclassification index (NRI). On multivariate analysis, five independent predictors associated with tumor recurrence were identified, including sex, γ-glutamyl transferase, macrovascular invasion, hilar lymphoid metastasis and adjuvant transcatheter arterial chemoembolization. The prediction score was constructed using these 5 variables, with scores ranging from 0 to 5. A patient with a score of 0 had a predicted 1- and 5-year recurrence risk of 11.1% and 22.2%, respectively. In the validation cohort, the NRIs of prediction score vs American Joint Committee on Cancer 7 TNM staging system at 1-year and 5-year were 0.185 (95% CI, 0.090-0.279, <0.001) and 0.425 (95% CI, 0.044-0.806, =0.03), respectively. Our developed and validated prediction score might be a simple and reliable method in postoperative CHC patients and help clinicians identify candidates who may benefit from future adjuvant therapies.
开发并验证一种决策辅助工具，以帮助对接受过联合肝细胞胆管癌（CHC）切除术的患者进行个体化的肿瘤复发风险评估。在1995年至2014年期间于中山医院接受肝切除术的208例患者的推导队列中，确定复发的风险因素，以建立一个预测评分。随后，使用C一致性统计量和净重新分类指数（NRI）在101例CHC患者的外部队列中对该模型进行验证。多因素分析确定了与肿瘤复发相关的五个独立预测因素，包括性别、γ-谷氨酰转移酶、大血管侵犯、肝门淋巴结转移和辅助性经动脉化疗栓塞。使用这5个变量构建预测评分，评分范围为0至5分。评分为0分的患者，其预测的1年和5年复发风险分别为11.1%和22.2%。在验证队列中，预测评分与美国癌症联合委员会第7版TNM分期系统在1年和5年时的NRI分别为0.185（95%CI，0.090-0.279，<0.001）和0.425（95%CI，0.044-0.806，=0.03）。我们开发并验证的预测评分可能是一种用于CHC术后患者的简单可靠方法，并有助于临床医生识别可能从未来辅助治疗中获益的患者。
