Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
BMC Surg. 2023 Jan 30;23(1):27. doi: 10.1186/s12893-023-01922-x.
The prognosis for hepatocellular carcinoma (HCC) is complex due to its high level of heterogeneity, even after radical resection. This study was designed to develop and validate a prognostic nomogram for predicting the postoperative prognosis for HCC patients following partial hepatectomy.
We extracted data on HCC patients and randomly divided them into two groups (primary and validation cohorts), using the Surveillance, Epidemiology and End Results (SEER) database. We developed the prediction model based on the data of the primary cohort and prognostic factors were evaluated using univariate and multivariate Cox regression analysis. A nomogram was constructed for predicting the 1-, 3-, and 5-year survival probability of HCC patients after surgery based on the results of the multivariate Cox regression analysis. The performance of the nomogram was evaluated in terms of its discrimination and calibration. To validated the model, discrimination and calibration were also evaluated in the validation cohort. Decision curve analysis (DCA) was performed to assess the clinical utility of the nomogram.
A total of 890 patients who underwent partial hepatectomy for HCC were included in the study. The primary cohort enrolled 628 patients with a median follow-up time of 39 months, the 1-, 3-, and 5-year survival rate were 95.4%, 52.7% and 25.8% during follow-up. Multivariate Cox regression analysis showed that differentiation, tumor size, AFP and fibrosis were independently association with the prognosis of HCC patients after partial hepatectomy. The nomogram showed a moderate discrimination ith a C-index of 0.705 (95% CI 0.669 to 0.742), and good calibration. Similar discrimination with a C-index of 0.681 (95% CI 0.625 to 0.737), and calibration were also observed in the validation cohort. Decision curve analysis showed that the nomogram could be useful to predicting the prognosis in HCC patients following partial hepatectomy.
The proposed nomogram is highly predictive and has moderate calibration and discrimination, potentially contributing to the process of managing HCC patients after partial hepatectomy in an individualized way.
由于其高度异质性，即使在根治性切除术后，肝细胞癌（HCC）的预后也很复杂。本研究旨在开发和验证一种用于预测 HCC 患者行部分肝切除术后术后预后的预测列线图。
我们从 SEER 数据库中提取 HCC 患者的数据，并将其随机分为两组（原始队列和验证队列）。我们根据原始队列的数据建立预测模型，并使用单变量和多变量 Cox 回归分析评估预后因素。根据多变量 Cox 回归分析的结果，构建用于预测 HCC 患者术后 1 年、3 年和 5 年生存率的列线图。通过评估判别和校准来评估列线图的性能。为了验证模型，还在验证队列中评估了判别和校准。通过决策曲线分析（DCA）评估列线图的临床实用性。
本研究共纳入 890 例接受 HCC 部分肝切除术的患者。原始队列纳入 628 例患者，中位随访时间为 39 个月，随访期间 1 年、3 年和 5 年生存率分别为 95.4%、52.7%和 25.8%。多变量 Cox 回归分析显示，分化、肿瘤大小、AFP 和纤维化与 HCC 患者部分肝切除术后的预后独立相关。列线图显示出中等的判别能力，C 指数为 0.705（95%CI 0.669-0.742），且校准良好。在验证队列中也观察到了相似的判别能力（C 指数为 0.681，95%CI 0.625-0.737）和校准。决策曲线分析表明，该列线图可用于预测 HCC 患者部分肝切除术后的预后。
该列线图具有高度预测性，且校准和判别能力适中，可能有助于对 HCC 患者行部分肝切除术后进行个体化管理。
