Zuo Dongliang, Li Yuntong, Liu Hongzhi, Liu Dongxu, Fang Qinliang, Li Pengtao, Tu Liang, Xiong Yu, Zeng Yongyi, Liu Pingguo
Department of Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Department of Hepatobiliary Surgery, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China.
J Clin Transl Hepatol. 2023 Jun 28;11(3):560-571. doi: 10.14218/JCTH.2022.00170. Epub 2022 Aug 30.
Hepatectomy is an effective treatment for selected patients with large hepatocellular carcinoma (HCC). This study aimed to develop a nomogram incorporating non-tumoral liver volume (non-TLV) and liver function markers to predict the patients' overall survival (OS) and disease-free survival (DFS).
Data of 198 consecutive large HCC patients who underwent hepatectomy at the Zhongshan Hospital Xiamen University were collected. Another 68 patients from the Mengchao Hepatobiliary Surgery Hospital served as an external validation cohort. The nomograms were developed based on the independent prognostic factors screened by multivariate Cox regression analyses. Concordance index (C-index), calibration curves, and time-dependent receiver operating characteristic (ROC) curves were used to measure the discrimination and predictive accuracy of the models.
High HBV DNA level, low non-TLV/ICG, vascular invasion, and a poorly differentiated tumor were confirmed as independent risk factors for both OS and DFS. The model established in this study predicted 5-year post-operative survival and DFS in good agreement with the actual observation confirmed by the calibration curves. The C-indexes of the nomograms in predicting OS and DFS were 0.812 and 0.823 in the training cohort, 0.821 and 0.846 in the internal validation cohort, and 0.724 and 0.755 in the external validation cohort. The areas under the ROC curves (AUCs) of nomograms for predicted OS and DFS at 1, 3, and 5 year were 0.85, 0.86, 0.83 and 0.76, 0.76, 0.63, respectively.
Nomograms with non-TLV/ICG predicted the prognosis of single large HCC patients accurately and effectively.
肝切除术是治疗部分大肝细胞癌（HCC）患者的有效方法。本研究旨在开发一种包含非肿瘤肝体积（non-TLV）和肝功能标志物的列线图，以预测患者的总生存期（OS）和无病生存期（DFS）。
收集了厦门大学附属中山医院连续198例接受肝切除术的大HCC患者的数据。另外68例来自孟超肝胆外科医院的患者作为外部验证队列。列线图基于多因素Cox回归分析筛选出的独立预后因素构建。一致性指数（C-index）、校准曲线和时间依赖性受试者工作特征（ROC）曲线用于衡量模型的辨别力和预测准确性。
高HBV DNA水平、低non-TLV/ICG、血管侵犯和肿瘤低分化被确认为OS和DFS的独立危险因素。本研究建立的模型预测的术后5年生存率和DFS与校准曲线证实的实际观察结果高度一致。训练队列中列线图预测OS和DFS的C指数分别为0.812和0.823，内部验证队列中为0.821和0.846，外部验证队列中为0.724和0.755。列线图预测1年、3年和5年OS和DFS的ROC曲线下面积（AUC）分别为0.85、0.86、0.83和0.76、0.76、0.63。
包含non-TLV/ICG的列线图能准确有效地预测单个大HCC患者的预后。
