随时间变化的mHAP-III是接受经动脉化疗栓塞的肝细胞癌患者生存的最准确预测指标。
Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.
作者信息
Campani Claudia, Vitale Alessandro, Dragoni Gabriele, Arena Umberto, Laffi Giacomo, Cillo Umberto, Giannini Edoardo G, Tovoli Francesco, Rapaccini Gian Ludovico, Di Marco Maria, Caturelli Eugenio, Zoli Marco, Sacco Rodolfo, Cabibbo Giuseppe, Mega Andrea, Guarino Maria, Gasbarrini Antonio, Svegliati-Baroni Gianluca, Foschi Francesco Giuseppe, Biasini Elisabetta, Masotto Alberto, Nardone Gerardo, Raimondo Giovanni, Azzaroli Francesco, Vidili Gianpaolo, Brunetto Maurizia Rossana, Farinati Fabio, Trevisani Franco, Marra Fabio
机构信息
Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
出版信息
Liver Cancer. 2021 Apr;10(2):126-136. doi: 10.1159/000513404. Epub 2021 Mar 17.
INTRODUCTION
The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC).
METHODS
An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016.
RESULTS
The median OS of the enrolled patients was 41 months. According to LRT χ and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, < 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10-1.55, < 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model.
CONCLUSION
An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.
引言
接受经动脉化疗栓塞术（TACE）的患者预后差异极大，一个混杂因素是TACE常常需要重复多次。我们回顾性评估了不同预后评分和分期系统在估计肝细胞癌（HCC）患者总生存期（OS）方面的准确性。
方法
进行了一项将预后模型视为随时间变化变量的分析，计算从TACE时间到后续治疗时间的OS。因此，每位患者的总随访时间被划分为几个观察期，每个观察期对应一次TACE操作。使用似然比检验（LRT）和赤池信息准则（AIC）的值来比较不同系统。进行单变量和多变量分析以确定其他预测OS的因素。我们分析了2008年至2016年意大利肝癌数据库中1058例患者所进行的1610次TACE。
结果
入组患者的中位OS为41个月。根据基于随时间变化分析的LRT χ值和AIC值，mHAP-III取得了最佳值（分别为41.72和4625.49，<0.0001），表明与所有其他评分（HAP、mHAP-II、ALBI和pALBI）及分期系统（MELD、ITALICA、CLIP、MESH、MESIAH、JIS、HKLC和BCLC）相比，其预测性能最高。在多变量Cox比例风险模型中，mHAP-III对OS保持独立影响（风险比1.31，95%CI：1.10 - 1.55，<0.0001）。多变量模型得出的其他显著变量包括随时间变化的年龄、酒精性病因、TACE的放射学反应以及TACE后进行消融或手术。
结论
一项创新性的随时间变化分析表明，mHAP-III是预测接受TACE的HCC患者OS的最准确模型。还发现其他TACE前后的临床变量与该预测相关。
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