Yang Yi, Ye Feng, Xin Yujing, Wang Yanan, Li Xiao, Feng Duiping, Chen Yi, Zhou Xiang
Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Gastrointest Oncol. 2020 Oct;11(5):1024-1039. doi: 10.21037/jgo-20-225.
Radiofrequency ablation (RFA) is a curative therapy for hepatocellular carcinoma (HCC) within Milan criteria. This study was conducted to evaluate the association between controlling nutritional status (CONUT) score and oncological outcomes in HCC patients within Milan criteria after RFA. Nomograms were constructed for the prediction of prognosis.
The study included 403 HCC patients within Milan criteria who underwent RFA at National Cancer Center and the First Hospital of Shanxi Medical University from January 2010 to December 2014. Oncological outcomes included disease-free survival (DFS) and overall survival (OS). The clinical variables were assessed by univariate and multivariate Cox regression analyses. C-index, time-dependent receiver operating characteristic (t-ROC) curve (t-AUC) and calibration plots were used to evaluate discrimination and calibration of the nomograms.
Patients were divided into CONUT ≤4 and ≥5 groups. The common prognostic factors affecting DFS and OS were number of lesions, tumor differentiation, and CONUT score. Age and total bilirubin (TBIL) were prognostic factors for OS only. Both DFS and OS rates in CONUT ≤4 group were significantly higher than those in CONUT ≥5 group (P=0.033, P<0.001). Two well-discriminated and calibrated nomograms were constructed to predict the probability of 1-, 2-, and 3-year DFS and 1-, 2-, 3-, 5-year OS with C-indexes of 0.798 and 0.757, respectively.
CONUT score is an independent prognostic factor for HCC after RFA treatment and a reliable indicator for nutritional interventions. Higher CONUT scores were associated with poor oncological outcomes. Nomograms based on CONUT score could efficiently predict DFS and OS for HCC patients within Milan criteria after RFA.
射频消融（RFA）是治疗符合米兰标准的肝细胞癌（HCC）的一种根治性疗法。本研究旨在评估符合米兰标准的HCC患者在接受RFA治疗后，控制营养状况（CONUT）评分与肿瘤学结局之间的关联。构建了列线图以预测预后。
本研究纳入了2010年1月至2014年12月期间在国家癌症中心和山西医科大学第一医院接受RFA治疗的403例符合米兰标准的HCC患者。肿瘤学结局包括无病生存期（DFS）和总生存期（OS）。通过单因素和多因素Cox回归分析评估临床变量。使用C指数、时间依赖性受试者工作特征（t-ROC）曲线（t-AUC）和校准图来评估列线图的辨别力和校准度。
患者被分为CONUT≤4组和≥5组。影响DFS和OS的常见预后因素为病灶数量、肿瘤分化程度和CONUT评分。年龄和总胆红素（TBIL）仅是OS的预后因素。CONUT≤4组的DFS和OS率均显著高于CONUT≥5组（P=0.033，P<0.001）。构建了两个辨别力和校准度良好的列线图，分别用于预测1年、2年和3年DFS以及1年、2年、3年和5年OS的概率，C指数分别为0.798和0.757。
CONUT评分是RFA治疗后HCC的独立预后因素，也是营养干预的可靠指标。CONUT评分越高，肿瘤学结局越差。基于CONUT评分的列线图可有效预测符合米兰标准的HCC患者在接受RFA治疗后的DFS和OS。
