Zhuang Hongkai, Zhou Zixuan, Ma Zuyi, Huang Shanzhou, Gong Yuanfeng, Zhang Zedan, Hou Baohua, Yu Weixuan, Zhang Chuanzhao
Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Shantou University of Medical College, Shantou, China.
Front Oncol. 2020 Nov 16;10:556489. doi: 10.3389/fonc.2020.556489. eCollection 2020.
Solitary large hepatocellular carcinoma (SLHCC) is a specific subtype of HCC with unique characteristics. It is of great interest to assess and stratify the prognosis of SLHCCs after curative resection. In this study, we tried to construct a prognostic nomogram for SLHCC following curative resection through a retrospective analysis of 202 SLHCC cases. Seven prognostic factors were identified and integrated to establish a novel prognostic nomogram, which included tumor size, microvascular invasion, tumor differentiation, Ki67 (%), α-fetoprotein (AFP), carbohydrate antigen 125 (CA125), and HBsAg status. The Harrell's concordance index (C-index) of the nomogram for overall survival (OS) in the training, validation, and whole sets was 0.752, 0.703, and 0.733, respectively. Furthermore, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the nomogram for predicting 1-, 3-, and 5-year OS indicated that the nomogram had an optimal discrimination of the prognostic prediction for SLHCC. The total score of each patient was calculated based on the nomogram, and patients were divided into three subgroups: low-risk group (total score ≦ 107), medium-risk group (107 < total score ≤ 125), and high-risk group (total score > 125). The 1-, 3-, and 5-year OS rates of the low-risk, medium-risk, and high-risk groups in the whole set were 89.3 vs. 70.1 vs. 33.3%, 76.6 vs. 37.8 vs. 14.5%, and 69.8 vs. 25.1 vs. 12.5%, respectively ( < 0.001). Similar results were shown in terms of the recurrence-free survival (RFS) rate. By analyzing 101 cases of recurrent tumors, transarterial chemoembolization (TACE) plus radiofrequency ablation (RFA)/surgery was found to prolong patient survival when compared to TACE alone in the low-risk group, but not in the medium/high-risk group. In conclusion, our prognostic nomogram successfully stratifies the prognosis for SLHCC after curative resection, which deserves further study in future clinical practice.
孤立性大肝细胞癌（SLHCC）是肝细胞癌的一种特殊亚型，具有独特的特征。评估根治性切除术后SLHCC的预后并进行分层具有重要意义。在本研究中，我们通过对202例SLHCC病例进行回顾性分析，试图构建根治性切除术后SLHCC的预后列线图。确定并整合了七个预后因素以建立一种新的预后列线图，其中包括肿瘤大小、微血管侵犯、肿瘤分化、Ki67（%）、甲胎蛋白（AFP）、糖类抗原125（CA125）和乙肝表面抗原（HBsAg）状态。该列线图在训练集、验证集和整个数据集中总生存（OS）的Harrell一致性指数（C指数）分别为0.752、0.703和0.733。此外，该列线图预测1年、3年和5年OS的受试者工作特征（ROC）曲线下面积（AUC）表明，该列线图对SLHCC的预后预测具有最佳的区分度。根据列线图计算每位患者的总分，患者被分为三个亚组：低风险组（总分≤107）、中风险组（107＜总分≤125）和高风险组（总分＞125）。整个数据集中低风险、中风险和高风险组的1年、3年和5年OS率分别为89.3%对70.1%对33.3%、76.6%对37.8%对14.5%、69.8%对25.1%对12.5%（P＜0.001）。无复发生存（RFS）率也显示出类似结果。通过分析101例复发性肿瘤病例，发现与单纯经动脉化疗栓塞术（TACE）相比，在低风险组中，TACE联合射频消融（RFA）/手术可延长患者生存期，但在中/高风险组中则不然。总之，我们的预后列线图成功地对根治性切除术后SLHCC的预后进行了分层，值得在未来的临床实践中进一步研究。
