Ji Kun, Zhu Hanlong, Wu Wei, Li Xin, Zhan Pengchao, Shi Yang, Sun Junhui, Li Zhen
Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, People's Republic of China.
Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, People's Republic of China.
J Hepatocell Carcinoma. 2022 Jun 7;9:537-551. doi: 10.2147/JHC.S360421. eCollection 2022.
To explore the tumor response and propose a nomogram-based prognostic stratification for hepatocellular carcinoma (HCC) after drug-eluting beads transarterial chemoembolization (DEB-TACE).
From the database of two centers, patients who received DEB-TACE as an initial treatment were enrolled and divided into the training and validation sets. The tumor response after DEB-TACE was estimated according to the Modified Response Evaluation Criteria in Solid Tumors. Using the independent survival predictors in the training set, a nomogram was constructed and validated internally and externally by measuring concordance index (C-index) and calibration. A prognostic stratification based on the nomogram was established.
A total of 335 patients met the inclusion criteria for the study. Alkaline phosphatase level, tumor maximum diameter, tumor capsule and portal vein invasion were interrelated with the achievement of complete release after DEB-TACE. Alpha-fetoprotein level, Child-Pugh class, tumor maximum diameter, tumor number, tumor extent and portal vein invasion were integrated into the nomogram. The nomogram demonstrated good calibration and discrimination, with C-indexes of 0.735 and 0.854 and higher area under the curve (AUC) than BCLC and CNLC staging systems in the internal and external validation sets. The prognostic stratification classified patients into three different risk groups, which had significant differences in survival, complete release and objective response rate between any two groups ( < 0.05).
The nomogram-based prognostic stratification has a good distinction and may help to identify the patients benefiting from DEB-TACE.
探讨经动脉化疗栓塞术（DEB-TACE）治疗肝细胞癌（HCC）后的肿瘤反应，并提出基于列线图的预后分层。
从两个中心的数据库中，纳入接受DEB-TACE作为初始治疗的患者，并分为训练集和验证集。根据实体瘤改良反应评估标准评估DEB-TACE后的肿瘤反应。利用训练集中的独立生存预测因素构建列线图，并通过测量一致性指数（C指数）和校准进行内部和外部验证。建立基于列线图的预后分层。
共有335例患者符合研究纳入标准。碱性磷酸酶水平、肿瘤最大直径、肿瘤包膜和门静脉侵犯与DEB-TACE后完全缓解的实现相关。甲胎蛋白水平、Child-Pugh分级、肿瘤最大直径、肿瘤数量、肿瘤范围和门静脉侵犯被纳入列线图。列线图显示出良好的校准和区分能力，内部和外部验证集中的C指数分别为0.735和0.854，曲线下面积（AUC）高于巴塞罗那临床肝癌（BCLC）和中国肝癌分期（CNLC）系统。预后分层将患者分为三个不同风险组，任意两组之间的生存、完全缓解和客观缓解率存在显著差异（<0.05）。
基于列线图的预后分层具有良好的区分度，可能有助于识别从DEB-TACE中获益的患者。
