Department of Liver Surgery and Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China.
Ann Surg Oncol. 2021 Nov;28(12):7647-7660. doi: 10.1245/s10434-021-09949-1. Epub 2021 Apr 26.
The effectiveness of clinical stage as a prognostic factor in combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) patients is controversial.
Medical records of all pathologically confirmed cHCC-CC patients from 2000 to 2017 at West China Hospital were retrieved. Tumor marker score (TMS) was determined from optimal AFP, CEA, and CA19-9 cutoff values. Interaction and subgroup analysis were conducted according to potential confounders. Prognostic value of TMS and other prognostic models were evaluated by Kaplan-Meier (K-M) analysis, c-index, and time-dependent receiver operating curves (td-ROC).
Optimal cutoff values for preoperative AFP, CEA, and CA19-9 were 10.76 ng/mL, 5.24 ng/mL, and 31.54 U/mL, respectively. Among 128 patients, 24, 58, and 46 were classified into TMS 0, TMS 1, and TMS ≥ 2, respectively. TMS could stratify our series into groups of statistically different prognosis. Subgroup analysis according to potential confounders and test for interactions showed that TMS 1 and TMS ≥ 2 were stable risk factors relative to TMS 0. Univariate (HR: TMS1 = 2.30, p = 0.014; TMS ≥ 2 = 5.1, p < 0.001) and multivariate Cox regression analyses (HR: TMS1 = 1.72, p = 0.124; TMS ≥ 2 = 4.15, p < 0.001) identified TMS as an independent prognostic risk factor. TMS had good discrimination (c-index 0.666, 95% CI 0.619-0.714), and calibration plots revealed favorable consistency. Area under the curve (AUC) value of td-ROC for TMS and integrated AUC was higher than for other clinical stages at any month within 5 years postoperation.
TMS exhibited optimal prognostic value over other widely used clinical stages for cHCC-CC after surgery and may guide clinicians in prognostic prediction.
临床分期作为合并肝细胞癌和胆管细胞癌（cHCC-CC）患者的预后因素的有效性存在争议。
回顾 2000 年至 2017 年在华西医院经病理证实的所有 cHCC-CC 患者的病历。通过最佳 AFP、CEA 和 CA19-9 截断值确定肿瘤标志物评分（TMS）。根据潜在混杂因素进行交互和亚组分析。通过 Kaplan-Meier（K-M）分析、c 指数和时间依赖性接收者操作曲线（td-ROC）评估 TMS 和其他预后模型的预后价值。
术前 AFP、CEA 和 CA19-9 的最佳截断值分别为 10.76ng/mL、5.24ng/mL 和 31.54U/mL。在 128 例患者中，分别将 24、58 和 46 例患者分为 TMS0、TMS1 和 TMS≥2 组。TMS 可将本研究分为具有统计学差异的预后组。根据潜在混杂因素和交互检验进行的亚组分析显示，与 TMS0 相比，TMS1 和 TMS≥2 是稳定的危险因素。单因素（HR：TMS1=2.30，p=0.014；TMS≥2=5.1，p<0.001）和多因素 Cox 回归分析（HR：TMS1=1.72，p=0.124；TMS≥2=4.15，p<0.001）均表明 TMS 是独立的预后危险因素。TMS 具有良好的判别能力（c 指数 0.666，95%CI 0.619-0.714），校准图显示一致性良好。在术后 5 年内的任何一个月，TMS 的时间依赖性 ROC 曲线下面积（AUC）值和综合 AUC 均高于其他临床分期。
TMS 对术后 cHCC-CC 的其他广泛使用的临床分期具有最佳的预后价值，可能有助于临床医生进行预后预测。
