Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
Cancer Med. 2019 Sep;8(11):5023-5032. doi: 10.1002/cam4.2417. Epub 2019 Jul 10.
There are large variations in prognosis among hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA). However, current staging or scoring systems hardly discriminate the outcome of HCC patients treated with RFA.
A total of 757 treatment-naïve HCC patients undergoing RFA (derivation cohort) were analyzed to establish a nomogram for disease-free survival (DFS) based on Cox proportional hazard regression model. Accuracy of the nomogram was assessed and compared with conventional staging or scoring systems. Furthermore, external validation was performed in an independent cohort including 208 patients (validation cohort).
Tumor size, tumor number, alpha-fetoprotein, prothrombin induced by vitamin K absence-II, lymphocyte count, albumin, and presence of ascites were adopted to construct the prognostic nomogram from the derivation cohort. Calibration curves to predict probability of DFS at 3 and 5 years after RFA showed good agreements between the nomogram and actual observations. The concordance index of the present nomogram was 0.759 (95% confidence interval 0.728-0.790), which was superior to those of conventional staging or scoring systems (range 0.505-0.683, all P < .001). These results were also reproduced in the validation cohort.
Our simple-to-use nomogram optimized for treatment-naïve HCC patients undergoing RFA provided better prognostic performance than conventional staging or scoring systems.
接受射频消融 (RFA) 的肝细胞癌 (HCC) 患者的预后存在很大差异。然而，目前的分期或评分系统几乎无法区分接受 RFA 治疗的 HCC 患者的结局。
对 757 例接受 RFA 的初治 HCC 患者 (推导队列) 进行分析，基于 Cox 比例风险回归模型建立无病生存 (DFS) 预测列线图。评估列线图的准确性，并与传统的分期或评分系统进行比较。此外，在包括 208 例患者的独立队列 (验证队列) 中进行外部验证。
从推导队列中采用肿瘤大小、肿瘤数量、甲胎蛋白、维生素 K 缺乏诱导的凝血酶原 II、淋巴细胞计数、白蛋白和腹水存在等因素构建了预后列线图。预测 RFA 后 3 年和 5 年 DFS 概率的校准曲线显示，列线图与实际观察结果之间具有良好的一致性。本列线图的一致性指数为 0.759(95%置信区间 0.728-0.790)，优于传统分期或评分系统(范围 0.505-0.683，均 P<0.001)。这些结果在验证队列中也得到了重现。
我们为接受 RFA 的初治 HCC 患者优化的简单易用的列线图提供了比传统分期或评分系统更好的预后性能。
