Huang Jian, Liu Fu-Chen, Li Li, Zhou Wei-Ping, Jiang Bei-Ge, Pan Ze-Ya
Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Department of Nephrology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Cancer Med. 2020 Apr;9(8):2791-2802. doi: 10.1002/cam4.2944. Epub 2020 Feb 25.
To develop and validate nomograms that can be used to predict outcomes in individuals suffering alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) after radical resection.
A total of 509 AFP-negative HCC patients who received hepatectomy between January 2009 and March 2013 in our center were randomized into training and validation cohorts. Nomograms for both overall and recurrence-free survival (OS and RFS, respectively) were established based on the predictors in the training cohort. Nomograms performance and discriminative power were assessed with concordance index (C-index) values and decision curve analyses (DCA). The results were validated in the validation cohort.
Alkaline phosphatase, liver cirrhosis, tumor size, satellite lesions, microvascular invasion, and Edmondson-Steiner grade were significantly linked to OS and RFS. Sex and tumor number were additional predictors for RFS. The OS nomogram had a C-index value of 0.742, which was better than that for the AJCC eighth edition (0.632), BCLC system (0.553), and JIS score (0.557) (all P < .001). The RFS nomogram C-index was 0.669, which was also superior to that of the AJCC eighth (0.608), BCLC stage (0.554), JIS score (0.551), and model of Gan et al (0.636) (P < .05 for all). Calibration curves indicated a good agreement between observed actual outcomes and predicted values. Kaplan-Meier curves and DCA indicated that nomograms were powerful in discrimination and clinical usefulness. These results were supported by the validation cohort.
These nomograms presented more accurate prognostic prediction in patients with AFP-negative HCC after hepatectomy.
开发并验证可用于预测甲胎蛋白（AFP）阴性肝细胞癌（HCC）患者根治性切除术后预后的列线图。
2009年1月至2013年3月在本中心接受肝切除术的509例AFP阴性HCC患者被随机分为训练组和验证组。根据训练组中的预测因素建立总生存和无复发生存（分别为OS和RFS）的列线图。用一致性指数（C指数）值和决策曲线分析（DCA）评估列线图的性能和鉴别力。结果在验证组中得到验证。
碱性磷酸酶、肝硬化、肿瘤大小、卫星灶、微血管侵犯和Edmondson-Steiner分级与OS和RFS显著相关。性别和肿瘤数量是RFS的额外预测因素。OS列线图的C指数值为0.742，优于美国癌症联合委员会（AJCC）第八版（0.632）、巴塞罗那临床肝癌（BCLC）系统（）0.553和日本综合分期系统（JIS）评分（0.557）（均P < 0.001）。RFS列线图的C指数为0.669，也优于AJCC第八版（0.608）、BCLC分期（0.554）、JIS评分（0.551）和Gan等人的模型（0.636）（均P < 0.05）。校准曲线表明观察到的实际结果与预测值之间具有良好的一致性。Kaplan-Meier曲线和DCA表明列线图在鉴别和临床实用性方面很强。这些结果得到了验证组的支持。
这些列线图对AFP阴性HCC患者肝切除术后的预后预测更准确。
