Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China.
Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China.
BMC Cancer. 2020 Oct 9;20(1):980. doi: 10.1186/s12885-020-07496-8.
Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear. Thus we aim to assess and compare prognosis values of different serum lipids, and construct a novel prognostic nomogram based on serum lipids.
Patients with a confirmed diagnosis of MBT at our institute from 2003 to 2017 were retrospectively reviewed. Prognosis-related factors were identified via univariate and multivariate Cox regression analyses. Then the novel prognostic nomogram and a 3-tier staging system were constructed based on these factors and further compared to the TNM staging system.
A total of 368 patients were included in this study. Seven optimal survival-related factors-TC/HDL > 10.08, apolipoprotein B > 0.9 g/L, lipoprotein> 72 mg/L, lymph node metastasis, radical cure, CA199 > 37 U/mL, and tumor differentiation -were included to construct the prognostic nomogram. The C-indexes in training and validation sets were 0.738 and 0.721, respectively. Besides, ROC curves, calibration plots, and decision curve analysis all suggested favorable discrimination and predictive ability. The nomogram also performed better predictive ability than the TNM system and nomogram without lipid parameters. And the staging system based on nomogram also presented better discriminative ability than TNM system (P < 0.001).
The promising prognostic nomogram based on lipid parameters provided an intuitive method for performing survival prediction and facilitating individualized treatment and was a great complement to the TNM staging system in predicting overall survival.
血清脂质被报道为各种癌症的预后因素，但它们在恶性胆道肿瘤（MBT）患者中的预后价值尚不清楚。因此，我们旨在评估和比较不同血清脂质的预后价值，并构建基于血清脂质的新的预后列线图。
回顾性分析了 2003 年至 2017 年在我院确诊为 MBT 的患者。通过单因素和多因素 Cox 回归分析确定与预后相关的因素。然后，根据这些因素构建新的预后列线图和 3 级分期系统，并与 TNM 分期系统进行比较。
本研究共纳入 368 例患者。包括 7 个与生存相关的最佳因素：TC/HDL>10.08、载脂蛋白 B>0.9g/L、脂蛋白>72mg/L、淋巴结转移、根治性治疗、CA199>37U/ml 和肿瘤分化。纳入构建预后列线图。训练集和验证集的 C 指数分别为 0.738 和 0.721。此外，ROC 曲线、校准图和决策曲线分析均表明该列线图具有良好的判别和预测能力。该列线图也比 TNM 系统和无脂质参数的列线图具有更好的预测能力。基于列线图的分期系统也比 TNM 系统具有更好的判别能力（P<0.001）。
基于脂质参数的有前途的预后列线图为生存预测提供了一种直观的方法，有助于个体化治疗，是对 TNM 分期系统预测总生存期的很好补充。
