Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO. 1 DaHua Road, Dong Dan, Beijing, 100730, PR China.
The Key Laboratory of geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
BMC Cancer. 2021 Jun 29;21(1):751. doi: 10.1186/s12885-021-08505-0.
Radiofrequency ablation (RFA) is an effective treatment option for hepatocellular carcinoma (HCC). This study aimed to analyze the prognostic factors of HCC patients treated with RFA and to develop nomograms for outcome prediction.
A total of 3142 HCC patients treated with RFA were recruited, and their data were collected from the Surveillance, Epidemiology, and End Results database. Univariate and multifactor Cox analyses were performed to identify independent prognostic factors. These factors were integrated into a nomogram to predict 3- and 5-year cancer-specific survival (CSS) and overall survival (OS). Consistency indices and calibration plots were used to assess the accuracy of the nomograms in both the internal and external cohorts.
The median follow-up periods for HCC patients treated with RFA were 27 and 29 months for OS and CSS, respectively. Marital status, age, race, histological grade of differentiation, tumor size, T stage, and serum alpha-fetoprotein levels at the time of diagnosis were identified as prognostic factors for OS and CSS. Additionally, M stage was identified as risk factors for OS. These risk factors are included in the nomogram. The calibration plots of the OS and CSS nomograms showed excellent consistency between actual survival and nomogram predictions. The bootstrap-corrected concordance indices of the OS and CSS nomograms were 0.637 (95% CI, 0.628-0.646) and 0.670 (95% 0.661-0.679), respectively. Importantly, our nomogram performed better discriminatory compared with 8th edition tumor-node-metastasis (TNM) stage system for predicting OS and CSS.
We identified prognostic factors for HCC patients treated with RFA and provided an accurate and personalized survival prediction scheme.
射频消融（RFA）是治疗肝细胞癌（HCC）的有效治疗选择。本研究旨在分析接受 RFA 治疗的 HCC 患者的预后因素，并开发用于预测结果的列线图。
共纳入 3142 例接受 RFA 治疗的 HCC 患者，其数据来自监测、流行病学和最终结果数据库。进行单因素和多因素 Cox 分析以确定独立的预后因素。这些因素被整合到一个列线图中，以预测 3 年和 5 年的癌症特异性生存率（CSS）和总生存率（OS）。一致性指数和校准图用于评估内部和外部队列中列线图的准确性。
接受 RFA 治疗的 HCC 患者的中位随访时间分别为 OS 和 CSS 的 27 和 29 个月。婚姻状况、年龄、种族、组织学分化程度、肿瘤大小、T 分期和诊断时的血清甲胎蛋白水平被确定为 OS 和 CSS 的预后因素。此外，M 期被确定为 OS 的危险因素。这些危险因素包含在列线图中。OS 和 CSS 列线图的校准图显示实际生存与列线图预测之间具有极好的一致性。OS 和 CSS 列线图的 bootstrap 校正一致性指数分别为 0.637（95%CI，0.628-0.646）和 0.670（95%CI，0.661-0.679）。重要的是，与第 8 版肿瘤-淋巴结-转移（TNM）分期系统相比，我们的列线图在预测 OS 和 CSS 方面具有更好的区分能力。
我们确定了接受 RFA 治疗的 HCC 患者的预后因素，并提供了一种准确且个性化的生存预测方案。
