Ge Bin, Zhuo Chenyi, Tang Qianli, Wu Yueqing
The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China.
Guangxi Hepatobiliary Disease Clinical Research Center, Baise, China.
Transl Pediatr. 2023 Feb 28;12(2):172-184. doi: 10.21037/tp-22-679. Epub 2023 Feb 24.
Hepatoblastoma (HB), hepatocellular carcinoma (HCC), and embryonal sarcoma (ES) are the three main types of liver tumors in children and adolescents. At present, epidemiological knowledge and predictors of these three liver tumor types in multi-ethnic populations are limited. This study aimed to outline the clinical features and construct a prognostic nomogram for these tumors, which can contribute to the prediction of dynamic overall survival probability during the follow-up period.
A total of 1,122 patients liver tumor patients between 2000 to 2019 in Surveillance, Epidemiology, and End Results (SEER) database were enrolled for the current study, and separated into 824 HB, 219 HCC, and 79 ES according to the type of pathology. Independent prognostic factors were screened by univariate and multivariate Cox regression analysis, and a prognostic nomogram was constructed for overall survival. The accuracy and discriminative abilities of the nomogram were evaluated by concordance index as well as time-dependent receiver operating characteristic curves and calibration curves.
Race (P=0.0016), surgery [hazard ratio (HR): 0.1021, P<0.001], and chemotherapy (HR: 0.27, P=0.00018) are independent prognostic factors for hepatoblastoma. Pathological tissue grading (P=0.00043), tumor node metastasis (TNM) staging (P=0.00061), and surgery are independent prognostic factors for hepatocellular carcinoma. Household income and surgery (HR: 0.1906, P<0.001) are independent prognostic factors for embryonal sarcoma. All of these prognostic factors are significantly associated with prognosis. A nomogram consisting of these variables was established, which showed a good concordance index (0.747, 0.775, and 0.828 in hepatoblastoma, hepatocellular carcinoma, and embryonal sarcoma, respectively). Also, the 5-year area under curve (AUC) of the nomogram were 0.738, 0.812, and 0.839 in hepatoblastoma, hepatocellular carcinoma, and embryonal sarcoma, respectively. In the calibration diagram, an optimal agreement between the nomogram-predicted and actual observed survival was evident.
We developed an effective prognostic nomogram for overall survival prediction in hepatoblastoma, hepatocellular carcinoma, and embryonal sarcoma in children and adolescent patients, which will further benefit the assessment of long-term outcomes.
肝母细胞瘤（HB）、肝细胞癌（HCC）和胚胎性肉瘤（ES）是儿童和青少年肝脏肿瘤的三种主要类型。目前，关于这三种肝脏肿瘤类型在多民族人群中的流行病学知识和预测因素有限。本研究旨在概述这些肿瘤的临床特征，并构建一个预后列线图，有助于预测随访期间的动态总生存概率。
本研究纳入了监测、流行病学和最终结果（SEER）数据库中2000年至2019年间的1122例肝脏肿瘤患者，并根据病理类型分为824例HB、219例HCC和79例ES。通过单因素和多因素Cox回归分析筛选独立预后因素，并构建总生存的预后列线图。通过一致性指数以及时间依赖性受试者操作特征曲线和校准曲线评估列线图的准确性和判别能力。
种族（P=0.0016）、手术[风险比（HR）：0.1021，P<0.001]和化疗（HR：0.27，P=0.00018）是肝母细胞瘤的独立预后因素。病理组织分级（P=0.00043）、肿瘤淋巴结转移（TNM）分期（P=0.00061）和手术是肝细胞癌的独立预后因素。家庭收入和手术（HR：0.1906，P<0.001）是胚胎性肉瘤的独立预后因素。所有这些预后因素均与预后显著相关。建立了一个由这些变量组成的列线图，其一致性指数良好（肝母细胞瘤、肝细胞癌和胚胎性肉瘤分别为0.747、0.775和0.828）。此外，列线图的5年曲线下面积（AUC）在肝母细胞瘤、肝细胞癌和胚胎性肉瘤中分别为0.738、0.812和0.839。在校准图中，列线图预测的生存与实际观察到的生存之间存在明显的最佳一致性。
我们开发了一种有效的预后列线图，用于预测儿童和青少年患者肝母细胞瘤、肝细胞癌和胚胎性肉瘤的总生存，这将进一步有助于评估长期预后。
