肉瘤样肝细胞癌列线图预后评估模型的建立与验证。

Development and Validation of a Nomogram-Based Prognostic Evaluation Model for Sarcomatoid Hepatocellular Carcinoma.

机构信息

Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.

出版信息

Adv Ther. 2020 Jul;37(7):3185-3205. doi: 10.1007/s12325-020-01357-3. Epub 2020 May 20.

DOI:10.1007/s12325-020-01357-3

PMID:32436026

Abstract

INTRODUCTION

Sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of liver cancer with extremely poor prognosis. This study aimed to identify the prognostic factors and develop an exclusive and efficient nomogram to predict cancer-specific survival (CSS) for SHC.

METHODS

The data on patients diagnosed with SHC from January 1973 to December 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and these patients were included as the training cohort. Least absolute shrinkage and selection operator (LASSO) and Cox proportional hazards regression analyses were used to identify the prognostic risk factors and construct a nomogram. The predictive accuracy and discriminative ability of the nomogram were determined using concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to compare the clinical benefits of the prognostic evaluation model (PEM) with that of the American Joint Committee on Cancer (AJCC) staging system. The results were validated with an external validation cohort.

RESULTS

In total, 116 patients with SHC were included in the training cohort. Multivariate Cox analysis revealed M stage (distant metastasis), primary tumor surgery, and chemotherapy to be associated with CSS, and along with tumor size, an integrated PEM was constructed. A calibration curve for the probability of survival showed good agreement between the nomogram and actual observation. The C-index value of the nomogram for predicting CSS and AJCC was 0.853 and 0.649, respectively. In the validation cohort, the C-index value of the PEM discrimination was better than that of the Barcelona Clinic Liver Cancer (BCLC) staging system, CLIP score, and Okuda staging system, and no statistical difference was observed with eighth edition of the AJCC staging system and Izumi staging system.

CONCLUSION

The proposed four-factor nomogram of PEM could accurately predict the prognosis of SHC and could be used in clinical practice.

摘要

简介

肉瘤样肝细胞癌（SHC）是一种罕见的肝癌亚型，预后极差。本研究旨在确定其预后因素，并开发一个专有的、有效的列线图来预测 SHC 的癌症特异性生存（CSS）。

方法

从 SEER 数据库中检索了 1973 年 1 月至 2015 年 12 月期间诊断为 SHC 的患者的数据，并将这些患者纳入训练队列。使用最小绝对收缩和选择算子（LASSO）和 Cox 比例风险回归分析来确定预后风险因素并构建列线图。通过一致性指数（C 指数）、校准曲线和接受者操作特征（ROC）曲线来确定列线图的预测准确性和区分能力。通过决策曲线分析（DCA）比较预后评估模型（PEM）与美国癌症联合委员会（AJCC）分期系统的临床获益。通过外部验证队列对结果进行了验证。

结果

共纳入 116 例 SHC 患者进行训练队列分析。多变量 Cox 分析显示 M 期（远处转移）、原发肿瘤手术和化疗与 CSS 相关，并且与肿瘤大小一起构建了一个综合 PEM。生存概率的校准曲线显示列线图与实际观察结果具有良好的一致性。列线图预测 CSS 和 AJCC 的 C 指数值分别为 0.853 和 0.649。在验证队列中，PEM 鉴别力的 C 指数值优于巴塞罗那临床肝癌（BCLC）分期系统、CLIP 评分和 Okuda 分期系统，与第八版 AJCC 分期系统和 Izumi 分期系统无统计学差异。