一种用于预测年轻肝细胞癌患者手术后预后的列线图。
A nomogram to predict prognosis after surgery for young patients with hepatocellular carcinoma.
作者信息
Li Xingchen, Bi Xinyu, Zhao Jianjun, Li Zhiyu, Zhou Jianguo, Huang Zhen, Zhang Yefan, Zhao Hong, Cai Jianqiang
机构信息
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Transl Cancer Res. 2021 Apr;10(4):1773-1786. doi: 10.21037/tcr-20-3411.
BACKGROUND
Only few studies have been evaluated the clinical characteristics and prognosis of hepatocellular carcinoma (HCC) in young patients. The purpose of this study is to identify prognostic factors and develop an efficient and practical nomogram to predict cancer-specific survival (CSS) in young patients with HCC.
METHODS
Four hundred and forty-one young patients with HCC who had undergone surgery from 2004-2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The competing risk model, Lasso and Cox regression were used to screen prognostic factors for CSS, and a prognostic nomogram was established using these factors. Thirty-nine young patients with HCC from the National Cancer Center, Cancer Hospital, Chinese Academy of Medical Science were used to validate our model. To further evaluate the predictive performance of our model, the concordance index was calculated and the calibration curves were drawn. The clinical usefulness was evaluated by decision curve analysis (DCA). Finally, all patients were grouped by our nomogram. The survival of different risk groups was analyzed using the Kaplan-Meier method, and the differences among survival curves were compared by the log-rank test.
RESULTS
The median survival times of the SEER training group and the external National Cancer Center validation group were 41 and 52 months, respectively. Histological grade, tumor size, Alpha-fetoprotein (AFP), T stage, and M stage were selected as independent factors for CSS, and a prognostic nomogram was established. The concordance indices of the training and external validation groups were 0.76 (95% CI, 0.72 to 0.80) and 0.92 (SE=0.085), respectively. The calibration plots showed good agreement. DCA revealed that our nomogram resulted in a better clinical net benefit than the AJCC 7th edition and Barcelona Clinic Liver Cancer staging systems. Patients were divided into two risk groups according to the cut-off value of 125 of the total points from our nomogram. Kaplan-Meier plots for CSS were performed using the log-rank test, the P-value of which was <0.001.
CONCLUSIONS
The practical nomogram resulted in a more-accurate prognostic prediction for young HCC patients after curative liver resection.
背景
仅有少数研究评估了年轻肝细胞癌（HCC）患者的临床特征和预后。本研究旨在确定预后因素，并开发一种有效且实用的列线图，以预测年轻HCC患者的癌症特异性生存（CSS）。
方法
从监测、流行病学和最终结果（SEER）数据库中选取了2004年至2015年期间接受手术的441例年轻HCC患者。采用竞争风险模型、Lasso和Cox回归筛选CSS的预后因素，并使用这些因素建立预后列线图。使用中国医学科学院肿瘤医院国家癌症中心的39例年轻HCC患者对我们的模型进行验证。为进一步评估我们模型的预测性能，计算一致性指数并绘制校准曲线。通过决策曲线分析（DCA）评估临床实用性。最后，根据我们的列线图对所有患者进行分组。采用Kaplan-Meier方法分析不同风险组的生存情况，并通过对数秩检验比较生存曲线之间的差异。
结果
SEER训练组和外部国家癌症中心验证组的中位生存时间分别为41个月和52个月。组织学分级、肿瘤大小、甲胎蛋白（AFP）、T分期和M分期被选为CSS的独立因素，并建立了预后列线图。训练组和外部验证组的一致性指数分别为0.76（95%CI，0.72至0.80）和0.92（SE = 0.085）。校准图显示出良好的一致性。DCA显示，与美国癌症联合委员会（AJCC）第7版和巴塞罗那临床肝癌分期系统相比，我们的列线图产生了更好的临床净效益。根据我们列线图总分125的临界值将患者分为两个风险组。使用对数秩检验对CSS进行Kaplan-Meier绘图，其P值<0.001。
结论
实用的列线图对根治性肝切除术后的年轻HCC患者预后预测更准确。
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