Chen C, Wu Y H, Zhang J W, Qiu Y H, Wu H, Li Q, Song T Q, He Y, Mao X H, Zhai W L, Cheng Z J, Li J D, Si S B, Cai Z Q, Geng Z M, Tang Z H
Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China.
School of Mechanical Engineering,Northwestern Polytechnical University,Xi'an 710072,China.
Zhonghua Wai Ke Za Zhi. 2021 Apr 1;59(4):265-271. doi: 10.3760/cma.j.cn112139-20201230-00891.
To examine a survival prognostic model applicable for patients with intrahepatic cholangiocarcinoma (ICC) based on Bayesian network. The clinical and pathological data of ICC patients who underwent curative intent resection in ten Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected.A total of 516 patients were included in the study.There were 266 males and 250 females.The median age(M(Q) was 58(14) years.One hundred and sixteen cases (22.5%) with intrahepatic bile duct stones,and 143 cases (27.7%) with chronic viral hepatitis.The Kaplan-Meier method was used for survival analysis.The univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model.One-year survival prediction models based on tree augmented naive Bayesian (TAN) and naïve Bayesian algorithm were established by Bayesialab software according to different variables,a nomogram model was also developed based on the independent predictors.The receiver operating characteristic curve and the area under curve (AUC) were used to evaluate the prediction effect of the models. The overall median survival time was 25.0 months,and the 1-,3-and 5-year cumulative survival rates was 76.6%,37.9%,and 21.0%,respectively.Univariate analysis showed that gender,preoperative jaundice,pathological differentiation,vascular invasion,microvascular invasion,liver capsule invasion,T staging,N staging,margin,intrahepatic bile duct stones,carcinoembryonic antigen,and CA19-9 affected the prognosis(χ=5.858-54.974, all <0.05).The Cox multivariate model showed that gender,pathological differentiation,liver capsule invasion,T stage,N stage,intrahepatic bile duct stones,and CA19-9 were the independent predictive factors(all <0.05). The AUC of the TAN model based on all 19 clinicopathological factors was 74.5%,and the AUC of the TAN model based on the 12 prognostic factors derived from univariate analysis was 74.0%,the AUC of the naïve Bayesian model based on 7 independent prognostic risk factors was 79.5%,the AUC and C-index of the nomogram survival prediction model based on 7 independent prognostic risk factors were 78.8% and 0.73,respectively. The Bayesian network model may provide a relatively accurate prognostic prediction for ICC patients after curative intent resection and performed superior to the nomogram model.
基于贝叶斯网络构建适用于肝内胆管癌(ICC)患者的生存预后模型。收集2010年1月至2018年12月在国内10家肝胆外科中心接受根治性切除的ICC患者的临床和病理资料。共纳入516例患者,其中男性266例,女性250例,年龄中位数(M(Q))为58(14)岁。116例(22.5%)合并肝内胆管结石,143例(27.7%)合并慢性病毒性肝炎。采用Kaplan-Meier法进行生存分析,分别用Log-rank检验和Cox比例风险模型进行单因素和多因素分析。利用Bayesialab软件根据不同变量建立基于树增强朴素贝叶斯(TAN)算法和朴素贝叶斯算法的1年生存预测模型,并基于独立预测因子构建列线图模型。采用受试者工作特征曲线及曲线下面积(AUC)评估模型预测效果。总体中位生存时间为25.0个月,1年、3年和5年累积生存率分别为76.6%、37.9%和21.0%。单因素分析显示,性别、术前黄疸、病理分化程度、血管侵犯、微血管侵犯、肝包膜侵犯、T分期、N分期、切缘、肝内胆管结石、癌胚抗原及CA19-9对预后有影响(χ=5.858 - 54.974,均P<0.05)。Cox多因素模型显示,性别、病理分化程度、肝包膜侵犯、T分期、N分期、肝内胆管结石及CA19-9为独立预测因子(均P<0.05)。基于全部19项临床病理因素的TAN模型的AUC为74.5%,基于单因素分析得出的12项预后因素的TAN模型的AUC为74.0%,基于7个独立预后风险因素的朴素贝叶斯模型的AUC为79.5%,基于7个独立预后风险因素的列线图生存预测模型的AUC和C指数分别为78.8%和0.73。贝叶斯网络模型可为根治性切除术后的ICC患者提供相对准确的预后预测,且其性能优于列线图模型。