Zhou Yongjie, Zhou Xin, Ma Jingqin, Zhang Wen, Yan Zhiping, Luo Jianjun
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Shanghai Institution of Medical Imaging, Shanghai, People's Republic of China.
Cancer Manag Res. 2021 Mar 1;13:2083-2094. doi: 10.2147/CMAR.S296020. eCollection 2021.
Only a few studies have investigated the clinical features and outcomes of patients with pulmonary metastasis from hepatocellular carcinoma (HCC) at the initial diagnosis. This study aimed to evaluate the prevalence, risk factors and prognostic factors related to pulmonary metastasis and then construct a nomogram to predict the outcomes of patients with HCC presenting with pulmonary metastasis.
The Surveillance, Epidemiology, and End Results (SEER) database was used to select patients. A total of 25,236 eligible patients diagnosed with HCC from 2010 to 2015 were selected. Then, 897 patients with HCC presenting with pulmonary metastasis at the initial diagnosis were included in the primary set (n=598) and validation set (n=299). Logistic and Cox regression analyses were used to determine the risk factors and prognostic factors for pulmonary metastasis. A nomogram predicting the prognosis of patients with HCC presenting with pulmonary metastasis was constructed based on independent prognostic factors identified in Cox regression analyses. Both internal and external validations of the nomogram were performed using discrimination and calibration plots.
The prevalence of pulmonary metastasis was 3.6% (897/25,236) in the entire cohort diagnosed with HCC as the initial diagnosis. Age, race, Edmonson-Steiner classification grade I/III, higher T stage, N stage, alpha fetoprotein(AFP) levels, brain metastasis, bone metastasis and intrahepatic metastasis were positively correlated with the development of HCC with pulmonary metastasis at the initial diagnosis. Prognostic factors incorporated in the nomogram were sex, T stage, bone metastasis, AFP levels, treatment, radiation and chemotherapy. The concordance index (C-index) of the nomogram in the primary set was 0.661 (95% CI: 0.633-0.688), indicating considerable predictive accuracy. The calibration curves showed consistency between the nomogram and the actual observations. When the nomogram was applied to the validation set, the results also remained reconcilable, and the C-index of the nomogram was 0.657 (95% CI: 0.626-0.698).
A list of risk factors associated with pulmonary metastasis occurrence in patients with HCC was selected, and the nomogram accurately predicted the prognosis of patients with HCC presenting with pulmonary metastasis at the initial diagnosis.
仅有少数研究调查了肝细胞癌（HCC）患者在初诊时肺转移的临床特征及预后。本研究旨在评估与肺转移相关的发生率、危险因素和预后因素，进而构建列线图以预测初诊时出现肺转移的HCC患者的预后。
利用监测、流行病学和最终结果（SEER）数据库选择患者。共选取了2010年至2015年期间诊断为HCC的25236例合格患者。然后，将897例初诊时出现肺转移的HCC患者纳入主要数据集（n = 598）和验证数据集（n = 299）。采用逻辑回归和Cox回归分析确定肺转移的危险因素和预后因素。基于Cox回归分析中确定的独立预后因素构建预测初诊时出现肺转移的HCC患者预后的列线图。使用区分度和校准图对列线图进行内部和外部验证。
在以HCC为初诊诊断的整个队列中，肺转移的发生率为3.6%（897/25236）。年龄、种族、Edmonson - Steiner分级I/III级、较高的T分期、N分期、甲胎蛋白（AFP）水平、脑转移、骨转移和肝内转移与初诊时HCC合并肺转移的发生呈正相关。列线图纳入的预后因素为性别、T分期、骨转移、AFP水平、治疗、放疗和化疗。主要数据集中列线图的一致性指数（C指数）为0.661（95%CI：0.633 - 0.688），表明具有相当的预测准确性。校准曲线显示列线图与实际观察结果一致。当将列线图应用于验证数据集时，结果也保持一致，列线图的C指数为0.657（95%CI：0.626 - 0.698）。
筛选出了与HCC患者发生肺转移相关的危险因素列表，且该列线图准确预测了初诊时出现肺转移的HCC患者的预后。
