Du Xia, Guo Cheng-Nan, Bao Xiao-Dong
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Department of Statistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Cancer Manag Res. 2021 Mar 17;13:2581-2594. doi: 10.2147/CMAR.S305253. eCollection 2021.
Conventional staging and scoring systems such as the Tumor, Node, and Metastasis; Cancer of the Liver Italian Program; Barcelona Clinic Liver Cancer; and Okuda have failed to predict overall survival (OS) in patients with resected primary hepatocellular carcinoma. Thus, we aimed to establish a novel D-index and nomogram to improve prognostic accuracy.
We selected 396 patients who underwent liver resection between January 2007 and February 2015 at the First Affiliated Hospital of Wenzhou Medical University. These patients were randomly divided into the training and validation groups in a ratio of 7:3.
We generated a nomogram using five independent risk factors, including the D-index (calculated by total bilirubin × tumor size/the ratio of fat-to-muscle area ) in the training set. The predictive performance of the nomogram was similar in both the training and validation cohorts according to the concordance index. The nomogram demonstrated the strongest predictive power for 1-year, 3-year, and 5-year OS, with the area under the receiving operating characteristic curve being 0.8486, 0.7785, and 0.752, respectively. The calibration curves exhibited stable capabilities in both cohorts. The stratification of the Kaplan-Meier curve was significant (P < 0.001).
The associated nomogram of the D-index demonstrated a powerful and accurate predictive ability for OS in patients with primary hepatocellular carcinoma.
传统的分期和评分系统，如肿瘤、淋巴结和转移（TNM）分期、意大利肝癌计划（CLIP）、巴塞罗那临床肝癌（BCLC）分期和奥田分期，均无法预测接受手术切除的原发性肝细胞癌患者的总生存期（OS）。因此，我们旨在建立一种新的D指数和列线图，以提高预后准确性。
我们选取了2007年1月至2015年2月在温州医科大学附属第一医院接受肝切除术的396例患者。这些患者按7:3的比例随机分为训练组和验证组。
我们在训练集中使用五个独立危险因素生成了列线图，其中包括D指数（通过总胆红素×肿瘤大小/脂肪与肌肉面积之比计算得出）。根据一致性指数，列线图在训练队列和验证队列中的预测性能相似。列线图对1年、3年和5年总生存期的预测能力最强，受试者工作特征曲线下面积分别为0.8486、0.7785和0.752。校准曲线在两个队列中均表现出稳定的性能。Kaplan-Meier曲线分层具有显著性（P<0.001）。
D指数相关列线图对原发性肝细胞癌患者的总生存期具有强大且准确的预测能力。
