应用aMAP风险评分预测中国人群肝细胞癌射频消融术后的晚期复发：一项多中心研究
Using the aMAP Risk Score to Predict Late Recurrence Following Radiofrequency Ablation for Hepatocellular Carcinoma in Chinese Population: A Multicenter Study.
作者信息
Yang Yi, Zhou Yanzhao, Zhang Xinyuan, Xin Yujing, Chen Yi, Fan Qingsheng, Li Xiao, Wei Xi, Li Qiang, Zhou Xiang, Zhou Jinxue
机构信息
Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, Henan Province, People's Republic of China.
出版信息
J Hepatocell Carcinoma. 2021 Jul 28;8:837-850. doi: 10.2147/JHC.S308587. eCollection 2021.
OBJECTIVE
This study was conducted to explore the application of age-male-ALBI-platelets (aMAP) score for predicting late recurrence of hepatocellular carcinoma (HCC) following radiofrequency ablation (RFA) and develop an aMAP score based-nomogram to predict prognosis in Chinese population.
MATERIALS AND METHODS
HCC patients who developed late recurrence following RFA at National Cancer Center (NCC) of China, First Hospital of Shanxi Medical University and Beijing Hospital of Traditional Chinese Medicine from January 2011 to December 2016 were included as a training cohort, and patients who were treated at Affiliated Cancer Hospital of Zhengzhou University between January 2012 and December 2016 were included as an external validation cohort. The optimal cut-off value for aMAP score was determined using X-tile software to discriminate the performance of recurrence-free survival (RFS).
RESULTS
A total of 339 eligible patients were included in this study. Patients were grouped into low-risk (aMAP score ≤64.2), medium-risk (64.3 ≤aMAP score ≤68.6) and high-risk (aMAP score ≥68.7) groups by X-tile plots. The prognostic factors that affected RFS were the number of lesions and aMAP score. A nomogram was constructed to predict the RFS with a C-index of 0.793 (95% CI: 0.744-0.842). The time-dependent receiver operating characteristic curves (t-AUCs) of the nomogram to predict 3, 4 and 5-year RFS were 0.808, 0.820 and 0.764, respectively. The model was then tested with data from an external validation cohort. The calibration curve confirmed the optimal agreement between the predicted and observed values.
CONCLUSION
The aMAP score provided a well-discriminated risk stratification and is an independent prognostic factor for the late recurrence of HCC following RFA. The aMAP score-based nomogram could help to strengthen prognosis-based decision making and formulate adjuvant therapeutic and preventive strategies.
目的
本研究旨在探讨年龄-男性-白蛋白-胆红素-血小板（aMAP）评分在预测肝细胞癌（HCC）射频消融（RFA）术后晚期复发中的应用，并建立基于aMAP评分的列线图以预测中国人群的预后。
材料与方法
纳入2011年1月至2016年12月在中国国家癌症中心、山西医科大学第一医院和北京中医医院接受RFA治疗后出现晚期复发的HCC患者作为训练队列，纳入2012年1月至2016年12月在郑州大学附属肿瘤医院接受治疗的患者作为外部验证队列。使用X-tile软件确定aMAP评分的最佳临界值，以区分无复发生存（RFS）的表现。
结果
本研究共纳入339例符合条件的患者。通过X-tile图将患者分为低风险组（aMAP评分≤64.2）、中风险组（64.3≤aMAP评分≤68.6）和高风险组（aMAP评分≥68.7）。影响RFS的预后因素为病灶数量和aMAP评分。构建了预测RFS的列线图，C指数为0.793（95%CI：0.744-0.842）。该列线图预测3年、4年和5年RFS的时间依赖性受试者工作特征曲线（t-AUC）分别为0.808、0.820和0.764。然后用来自外部验证队列的数据对该模型进行测试。校准曲线证实了预测值与观察值之间的最佳一致性。
结论
aMAP评分提供了良好区分的风险分层，是HCC患者RFA术后晚期复发的独立预后因素。基于aMAP评分的列线图有助于加强基于预后的决策制定，并制定辅助治疗和预防策略。
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