Dong Wei, Yan Kai, Yu Hua, Huo Lei, Xian Zhihong, Zhao Yanqing, Li Jutang, Zhang Yuchan, Cao Zhenying, Fu Yong, Cong Wenming, Dong Hui
Department of Pathology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai, China.
Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer, the Second Military Medical University, Shanghai, China.
Front Oncol. 2021 Feb 11;10:605057. doi: 10.3389/fonc.2020.605057. eCollection 2020.
Predicting the long-term prognosis of individuals who experienced sorafenib treatment following partial hepatectomy due to hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) is difficult. This work aims to create an effective prognostic nomogram for HBV related HCC patients who are receiving sorafenib treatment as adjuvant therapy after surgery.
A total of 233 HBV-related HCC patients treated with or without sorafenib following partial hepatectomy at the Eastern Hepatobiliary Surgery Hospital from 2008 to 2013 were matched with propensity score matching analysis. The optimal cut-off point of the overall survival (OS) factor level was determined by x-tile. The selection of indicators was based on clinical findings. The Cox regression model with an interaction term was employed for evaluating the predictive value. Using a multivariate Cox proportional hazards model, a nomogram was subsequently formulated to analyze 111 patients treated with sorafenib. The nomogram's discriminative ability and predictive accuracy were determined using the concordance index (C-index), calibration, and ROC curve.
The matched sorafenib cohort of 111 patients and control cohort of 118 patients were analyzed. Subgroup analysis revealed that low GPC3, pERK, pAKT, serum AFP levels, without MVI, under 50 years old, male, TNM stage I/II and BCLC stage 0/A were significantly associated with a better OS in patients subjected to sorafenib treatment compared to those without sorafenib treatment after surgery. Multivariate analysis of the sorafenib cohort revealed GPC3, pERK, pAKT, serum AST, and BCLC stage as independent factors for OS, and all were included in the nomogram. The survival probability based on the calibration curve showed that the prediction of the nomogram was in good agreement with the actual observation. The C-index of the nomogram for predicting survival was 0.73(95% CI, 0.67-0.78). The area under the ROC curve (AUC) for the nomogram to predict the survival for 1, 3, and 5-year was 0.726, 0.816, and 0.823, respectively.
This proposed nomogram shows the potential to make a precise prediction regarding the prognosis of HBV-related HCC patients and may help to stratify patients for personalized therapy following partial hepatectomy.
预测因乙型肝炎病毒（HBV）相关肝细胞癌（HCC）接受部分肝切除术后接受索拉非尼治疗的个体的长期预后很困难。这项工作旨在为术后接受索拉非尼辅助治疗的HBV相关HCC患者创建一个有效的预后列线图。
对2008年至2013年在东方肝胆外科医院接受或未接受索拉非尼治疗的233例HBV相关HCC患者进行倾向评分匹配分析。通过x-tile确定总生存（OS）因素水平的最佳截断点。指标的选择基于临床发现。采用带有交互项的Cox回归模型评估预测价值。随后使用多变量Cox比例风险模型，为111例接受索拉非尼治疗的患者制定列线图。使用一致性指数（C指数）、校准和ROC曲线确定列线图的判别能力和预测准确性。
分析了111例索拉非尼匹配队列患者和118例对照队列患者。亚组分析显示，与术后未接受索拉非尼治疗的患者相比，接受索拉非尼治疗的患者中低GPC3、pERK、pAKT、血清AFP水平，无微血管侵犯（MVI），年龄小于50岁，男性，TNM分期I/II期和BCLC分期0/A期与更好的OS显著相关。对索拉非尼队列的多变量分析显示，GPC3、pERK、pAKT、血清AST和BCLC分期是OS的独立因素，所有这些因素都纳入了列线图。基于校准曲线的生存概率表明，列线图的预测与实际观察结果高度一致。预测生存的列线图的C指数为0.73（95%CI，0.67 - 0.78）。列线图预测1年、3年和5年生存的ROC曲线下面积（AUC）分别为0.726、0.816和0.823。
该列线图显示了对HBV相关HCC患者预后进行精确预测的潜力，并可能有助于对部分肝切除术后的患者进行分层以制定个性化治疗方案。
