Huang Wen-Yen, Tsai Chiao-Ling, Que Jenny Y, Lo Cheng-Hsiang, Lin Yu-Ju, Dai Yang-Hong, Yang Jen-Fu, Shen Po-Chien, Lee Mei-Hsuan, Cheng Jason Chia-Hsien
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Liver Cancer. 2020 Jun;9(3):326-337. doi: 10.1159/000505693. Epub 2020 Mar 10.
Stereotactic body radiotherapy (SBRT) is an emerging treatment modality for hepatocellular carcinoma (HCC) with promising outcome. However, appropriate survival prediction models are scarce. This study aimed to develop a simple and clinically useful prognostic nomogram for patients with nondistant metastatic Barcelona Clinic Liver Cancer (BCLC) stage C HCC undergoing SBRT.
The data were based on a prospective multi-institutional registry enrolling 246 patients with nondistant metastatic BCLC stage C HCC treated with SBRT between January 1, 2008 and December 31, 2016. They were randomly divided into two subsets: 164 into the development cohort and 82 into the validation cohort. We identified and included prognostic factors for survival to derive a nomogram in the development cohort. The predictability of the nomogram was evaluated in the validation cohort. The area under the receiver operating characteristic curve (AUROC) and the calibration plot were used to evaluate the performance of the nomogram.
The median survival was 13.5 months, with 1- and 2-year overall survival (OS) rates of 55.0 and 32.9%, respectively. Number of tumors, largest tumor size, macrovascular invasion, Child-Turcotte-Pugh class, and biologically effective dose were significantly associated with OS ( < 0.05). These predictors were included to develop a nomogram with an AUROC of 0.77 (0.73-0.87). The prediction model was well calibrated in the validation cohort. The OS for patients who were divided by their risk scores differed significantly ( < 0.001).
The nomogram we generated had discriminatory and satisfactory predictability for OS among nonmetastatic BCLC stage C HCC patients treated with SBRT. It demands further validations with cross-country data to confirm its worldwide usefulness.
立体定向体部放疗（SBRT）是一种用于肝细胞癌（HCC）的新兴治疗方式，疗效前景良好。然而，合适的生存预测模型却很匮乏。本研究旨在为接受SBRT的非远处转移巴塞罗那临床肝癌（BCLC）C期HCC患者开发一种简单且临床实用的预后列线图。
数据基于一项前瞻性多机构注册研究，纳入了2008年1月1日至2016年12月31日期间接受SBRT治疗的246例非远处转移BCLC C期HCC患者。他们被随机分为两个亚组：164例进入开发队列，82例进入验证队列。我们识别并纳入生存预后因素以在开发队列中得出列线图。在验证队列中评估列线图的预测能力。采用受试者操作特征曲线下面积（AUROC）和校准图来评估列线图的性能。
中位生存期为13.5个月，1年和2年总生存率（OS）分别为55.0%和32.9%。肿瘤数量、最大肿瘤大小、大血管侵犯、Child-Turcotte-Pugh分级和生物等效剂量与OS显著相关（<0.05）。纳入这些预测因素以开发一个AUROC为0.77（0.73 - 0.87）的列线图。该预测模型在验证队列中校准良好。根据风险评分划分的患者的OS有显著差异（<0.001）。
我们生成的列线图对于接受SBRT治疗的非转移性BCLC C期HCC患者的OS具有鉴别能力和令人满意的预测性。需要通过跨国数据进行进一步验证以确认其在全球范围内的实用性。
