开发并验证一种新型在线计算器，用于估算接受手术治疗的肝细胞癌患者接受辅助经导管动脉化疗栓塞的生存获益。
Development and validation of a novel online calculator for estimating survival benefit of adjuvant transcatheter arterial chemoembolization in patients undergoing surgery for hepatocellular carcinoma.
机构信息
Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People' Hospital of Hangzhou Medical College, No. 158, Shangtang Road, Hangzhou, 310014, Zhejiang, China.
Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China.
出版信息
J Hematol Oncol. 2021 Oct 12;14(1):165. doi: 10.1186/s13045-021-01180-5.
BACKGROUND AND AIMS
Although adjuvant transcatheter arterial chemoembolization (TACE) for resected hepatocellular carcinoma (HCC) may improve survival for some patients, identifying which patients can benefit remains challenging. The present study aimed to construct a survival prediction calculator for individualized estimating the net survival benefit of adjuvant TACE for patients with resected HCC.
METHODS
From a multicenter database, consecutive patients undergoing curative resection for HCC were enrolled and divided into the developing and validation cohorts. Using the independent survival predictors in the developing cohort, two nomogram models were constructed for patients with and without adjuvant TACE, respectively, which predictive performance was validated internally and externally by measuring concordance index (C-index) and calibration. The difference between two estimates of the prediction models was the expected survival benefit of adjuvant TACE.
RESULTS
A total of 2514 patients met the inclusion criteria for the study. The nomogram prediction models for patients with and without adjuvant TACE were, respectively, built by incorporating the same eight independent survival predictors, including portal hypertension, Child-Pugh score, alpha-fetoprotein level, tumor size and number, macrovascular and microvascular invasion, and resection margin. These two prediction models demonstrated good calibration and discrimination, with all the C-indexes of greater than 0.75 in the developing and validation cohorts. A browser-based calculator was generated for individualized estimating the net survival benefit of adjuvant TACE.
CONCLUSIONS
Based on large-scale real-world data, an easy-to-use online calculator can be adopted as a decision aid to predict which patients with resected HCC can benefit from adjuvant TACE.
背景与目的
尽管辅助经导管动脉化疗栓塞（TACE）治疗可切除肝细胞癌（HCC）可能会改善某些患者的生存，但确定哪些患者受益仍然具有挑战性。本研究旨在构建一个生存预测计算器，用于个体化估计辅助 TACE 对可切除 HCC 患者的净生存获益。
方法
从一个多中心数据库中，纳入接受根治性切除 HCC 的连续患者，并将其分为开发和验证队列。使用开发队列中的独立生存预测因素，分别为接受和未接受辅助 TACE 的患者构建了两个列线图模型，通过测量一致性指数（C 指数）和校准来内部和外部验证预测性能。两个预测模型之间的差异是辅助 TACE 的预期生存获益。
结果
共有 2514 名患者符合本研究的纳入标准。通过纳入相同的 8 个独立生存预测因素，包括门静脉高压、Child-Pugh 评分、甲胎蛋白水平、肿瘤大小和数量、大血管和微血管侵犯以及切缘，为接受和未接受辅助 TACE 的患者分别构建了列线图预测模型。这两个预测模型具有良好的校准和区分度，开发和验证队列的所有 C 指数均大于 0.75。生成了一个基于浏览器的计算器，用于个体化估计辅助 TACE 的净生存获益。
结论
基于大规模真实世界数据，可以采用易于使用的在线计算器作为决策辅助工具，以预测哪些接受可切除 HCC 治疗的患者可以从辅助 TACE 中获益。
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