Xu Yang, Han Huimin, Cao Wei, Fu Hongxing, Liu Yang, Yan Li, Qin Tingting
Department of Integrated Traditional Chinese and Western Medicine, Wuhan Third Hospital, Wuhan, China.
Department of Traditional Chinese Medicine, Wuhan Third Hospital, Wuhan, China.
J Gastrointest Oncol. 2023 Feb 28;14(1):278-286. doi: 10.21037/jgo-22-1303. Epub 2023 Feb 15.
In recent years, nomogram prediction models have been widely used to evaluate the prognosis of various diseases. However, studies in primary hepatocellular carcinoma (HCC) are limited. This study sought to explore the risk factors of recurrence of patients with primary HCC after surgical resection and establish a nomogram prediction model.
The data of 424 patients with primary HCC who had been admitted to the Wuhan Third Hospital were retrospectively collected. The patients were followed-up for 5 years after surgery. The patients were divided into the recurrence group (n=189) and control group (n=235) according to whether the cancer recurred after surgery. The differences in the clinical characteristics between the two groups were analyzed. The risk factors of recurrence after surgical resection of primary HCC were also analyzed, and a prediction model was then established using R4.0.3 statistical software.
There were significant statistical differences between the two groups in terms of the tumor size, systemic immune-inflammation (SII) index, the number of lesions, tumor differentiation degree, ascites, vascular invasion, and portal vein tumor thrombus (P<0.05). The multivariate regression analysis showed that multiple foci, poorly differentiated tumors, ascites, vascular invasion, and portal vein tumor thrombus were risk factors for the recurrence of primary HCC in patients after surgical resection (P<0.05). The data set was randomly divided into a training set and verification set. The sample size of the training set was 297, and the sample size of the verification set was 127. The area under the receiver operating characteristic (ROC) curve of the training set was 0.866 [95% confidence interval (CI): 0.824-0.907], and the area under the ROC curve of the validation set was 0.812 (95% CI: 0.734-0.890). The Hosmer-Lemeshow Goodness-of-Fit Test was used to test the model with the validation set (χ=11.243, P=0.188), which indicated that the model had high value in predicting the recurrence of primary HCC after surgical resection.
This model had high value in predicting the recurrence of primary HCC in patients after surgical resection. This model could assist clinicians to assess the prognosis of patients. Intensive treatment for high-risk patients might improve the prognosis of patients.
近年来，列线图预测模型已被广泛用于评估各种疾病的预后。然而，关于原发性肝细胞癌（HCC）的研究有限。本研究旨在探讨原发性HCC患者手术切除后复发的危险因素，并建立列线图预测模型。
回顾性收集武汉市第三医院收治的424例原发性HCC患者的数据。术后对患者进行5年随访。根据术后癌症是否复发，将患者分为复发组（n = 189）和对照组（n = 235）。分析两组患者临床特征的差异。分析原发性HCC手术切除后复发的危险因素，然后使用R4.0.3统计软件建立预测模型。
两组在肿瘤大小、全身免疫炎症（SII）指数、病灶数量、肿瘤分化程度、腹水、血管侵犯和门静脉癌栓方面存在显著统计学差异（P < 0.05）。多因素回归分析显示，多发病灶、低分化肿瘤、腹水、血管侵犯和门静脉癌栓是原发性HCC患者手术切除后复发的危险因素（P < 0.05）。将数据集随机分为训练集和验证集。训练集样本量为297，验证集样本量为127。训练集的受试者工作特征（ROC）曲线下面积为0.866 [95%置信区间（CI）：0.824 - 0.907]，验证集的ROC曲线下面积为0.812（95% CI：0.734 - 0.890）。使用Hosmer-Lemeshow拟合优度检验对验证集进行模型检验（χ = 11.243，P = 0.188），表明该模型在预测原发性HCC手术切除后复发方面具有较高价值。
该模型在预测原发性HCC患者手术切除后复发方面具有较高价值。该模型可协助临床医生评估患者预后。对高危患者进行强化治疗可能改善患者预后。
