Li Z, Xie B C, Lyu P J, Wang H X, Li Y, Wang C H, Li X, Ye S W, Li G, Pang P F, Zhang Y Y, Yu P
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University;Engineering Technology Research Center for Minimally Invasive Interventional Tumors of Henan Province,Zhengzhou 450052, China.
Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2023 Apr 25;103(16):1217-1224. doi: 10.3760/cma.j.cn112137-20221124-02483.
To investigate the clinical value and efficacy of the nomogram model in evaluating the prognosis of cholangiocarcinoma after interventional therapy. The clinical data of 259 patients with cholangiocarcinoma who received interventional therapy at the First Affiliated Hospital of zhengzhou University from January 2014 to June 2021 were retrospectively analyzed, including 148 males and 111 females, aged from 26 to 91 (65±12) years. They were randomly divided into a training group (181 cases) and a validation group (78 cases) in a ratio of 7∶3. Cox regression analysis was performed in the training group, independent risk factors affecting the prognosis of patients were screened, and a nomogram for 6-month, 1-year, and 2-year survival was constructed. The performance of the nomogram was analyzed by calculating the area under the receiver operating characteristic curve (AUC) value, calibration curve, and decision curve, and the predictive efficacy of the model was evaluated in the validation group. There was no significant difference in baseline data between the training group and the validation group, which was comparable. Regression analysis showed that T stage (T2: =0.147,95%: 0.077-0.281;T3: =0.207,95%: 0.122-0.351;T4: =0.864,95%: 0.537-1.393), tumor diameter (17-33 mm: =0.201,95%: 0.119-0.341;≥33 mm: =0.795,95%: 0.521-1.211) and differentiation degree(middle differentiation: =3.318,95%: 2.082-5.289;highly differentiation: =1.842,95%: 1.184-2.867) were risk factors affecting the prognosis of interventional therapy for cholangiocarcinoma. The AUC values of the survival curve prediction models were generally consistent between the training and validation groups, and the AUC values of the training group at 6 months, 1 year, and 2 years were 0.925 (95%: 0.888-0.963), 0.921 (95%: 0.877-0.964) and 0.974 (95%: 0.957-0.993), respectively. In the validation group, the 6-month, 1-year, and 2-year AUC values were 0.951 (95%: 0.911-0.991), 0.917 (95%: 0.857-0.977) and 0.848 (95%: 0.737-0.959), respectively, and the AUC values were all greater than 0.8, suggesting that the nomogram had better discrimination ability. The calibration curves of the prediction models of the two groups were basically consistent, and the shape of the calibration curves at 6 months and 1 year fitted the ideal curve, while the fitting degree of the calibration curves at 2 years was relatively poor. The decision curve showed the high clinical utility of this nomogram in predicting the 6-month, 1-year survival of patients with cholangiocarcinoma. T stage, tumor diameter, and differentiation are independent risk factors affecting the prognosis of patients with interventional cholangiocarcinoma, and the nomogram model proposed in this study has good distinguishing ability and exact clinical value for prognosis evaluation.
探讨列线图模型在评估胆管癌介入治疗后预后的临床价值及疗效。回顾性分析2014年1月至2021年6月在郑州大学第一附属医院接受介入治疗的259例胆管癌患者的临床资料,其中男性148例,女性111例,年龄26~91(65±12)岁。按7∶3比例随机分为训练组(181例)和验证组(78例)。在训练组进行Cox回归分析,筛选影响患者预后的独立危险因素,构建6个月、1年和2年生存列线图。通过计算受试者操作特征曲线(AUC)下面积、校准曲线和决策曲线分析列线图性能,并在验证组评估模型预测疗效。训练组和验证组基线数据无显著差异,具有可比性。回归分析显示,T分期(T2:=0.147,95%:0.077 - 0.281;T3:=0.207,95%:0.122 - 0.351;T4:=0.864,95%:0.537 - 1.393)、肿瘤直径(17~33 mm:=0.201,95%:0.119 - 0.341;≥33 mm:=0.795,95%:0.521 - 1.211)和分化程度(中分化:=3.318,95%:
2.082 - 5.289;高分化:=1.842,95%:1.184 - 2.867)是影响胆管癌介入治疗预后的危险因素。训练组和验证组生存曲线预测模型的AUC值总体一致,训练组6个月、1年和2年的AUC值分别为0.925(95%:0.888 - 0.963)、0.921(95%:0.877 - 0.964)和0.974(95%:0.957 - 0.993)。验证组6个月、1年和2年的AUC值分别为0.951(95%:0.911 - 0.991)、0.917(95%:0.857 - 0.977)和0.848(95%:0.737 - 0.959),AUC值均大于0.8,提示列线图具有较好的区分能力。两组预测模型的校准曲线基本一致,6个月和1年校准曲线形状拟合理想曲线,而2年校准曲线拟合度相对较差。决策曲线显示该列线图在预测胆管癌患者6个月、1年生存方面具有较高的临床实用性。T分期、肿瘤直径和分化是影响胆管癌介入治疗患者预后的独立危险因素,本研究提出的列线图模型对预后评估具有良好的区分能力和确切的临床价值。