Medical School, Southeast University, Nanjing, China.
Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Gastroenterol. 2022 Jul 19;22(1):348. doi: 10.1186/s12876-022-02424-5.
Hepatocellular carcinoma (HCC) is a kind of tumor with high invasiveness, and patients with advanced HCC have a higher risk of early death. The aim of the present study was to identify the risk factors of early death in patients with advanced HCC and establish predictive nomograms.
Death that occurred within 3 months of initial diagnosis is defined as early death. Patients diagnosed with stage IV HCC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results database for model establishment and verification. Univariable and multivariable logistic regression analyses were used to identify the risk factors. Predictive nomograms were constructed and an internal validation was performed. Decision curve analysis (DCA) was used to verify the true clinical application value of the models.
Of 6603 patients (57% age > 60, 81% male, 70% white, 46% married), 21% and 79% had stage IVA and IVB, respectively. On the multivariable analyses, risk factors for early deaths in patients with stage IVA were age, tumor size, histological grade, alpha-fetoprotein (AFP), fibrosis score, tumor stage (T stage), surgery, radiotherapy, and chemotherapy, and that in stage IVB were age, histological grade, AFP, T stage, node stage (N stage), bone metastasis, lung metastasis, surgery, radiotherapy, and chemotherapy. The areas under the curves (AUCs) were 0.830 (95% CI 0.809-0.851) and 0.789 (95% CI 0.768-0.810) in stage IVA and IVB, respectively. Nomograms comprising risk factors with the concordance indexes (C-indexes) were 0.820 (95% CI 0.799-0.841) in stage IVA and 0.785 (95% CI 0.764-0.0.806) in stage IVB for internal validation (Bootstrapping, 1000re-samplings). The calibration plots of the nomograms show that the predicted early death was consistent with the actual value. The results of the DCA analysis show that the nomograms had a good clinical application.
The nomograms can be beneficial for clinicians in identifying the risk factors for early death of patients with advanced HCC and predicting the probability of early death, so as to allow for individualized treatment plans to be accurately selected.
肝细胞癌（HCC）是一种侵袭性很强的肿瘤，晚期 HCC 患者的早期死亡风险较高。本研究旨在确定晚期 HCC 患者早期死亡的危险因素，并建立预测列线图。
将诊断后 3 个月内死亡定义为早期死亡。从 2010 年至 2015 年，从监测、流行病学和最终结果数据库中收集诊断为 IV 期 HCC 的患者用于模型建立和验证。采用单变量和多变量逻辑回归分析确定危险因素。构建预测列线图并进行内部验证。决策曲线分析（DCA）用于验证模型的真实临床应用价值。
在 6603 例患者中（57%年龄>60 岁，81%为男性，70%为白人，46%已婚），分别有 21%和 79%为 IVA 期和 IVB 期。多变量分析显示，IVA 期患者早期死亡的危险因素为年龄、肿瘤大小、组织学分级、甲胎蛋白（AFP）、纤维化评分、肿瘤分期（T 分期）、手术、放疗和化疗，IVB 期患者的危险因素为年龄、组织学分级、AFP、T 分期、淋巴结分期（N 分期）、骨转移、肺转移、手术、放疗和化疗。IVA 期和 IVB 期的曲线下面积（AUC）分别为 0.830（95%置信区间 0.809-0.851）和 0.789（95%置信区间 0.768-0.810）。包含一致性指数（C-index）的危险因素列线图在 IVA 期和 IVB 期分别为 0.820（95%置信区间 0.799-0.841）和 0.785（95%置信区间 0.764-0.806）。列线图的校准图显示，预测的早期死亡与实际值一致。DCA 分析结果表明，该列线图具有良好的临床应用价值。
该列线图有助于临床医生识别晚期 HCC 患者早期死亡的危险因素，并预测早期死亡的概率，从而能够准确选择个体化治疗方案。
