Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
The First Clinical Medical College, Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China.
World J Gastroenterol. 2023 May 28;29(20):3168-3184. doi: 10.3748/wjg.v29.i20.3168.
The efficacy of conversion therapy for patients with unresectable hepatocellular carcinoma (HCC) is a common clinical concern.
To analyse the prognostic factors of overall survival (OS) in patients with unresectable HCC who received conversion therapy.
One hundred and fifty patients who met the inclusion criteria were enrolled and divided into a training cohort ( = 120) and a validation cohort ( = 30). Using the independent risk factors in the training cohort, a nomogram model was constructed to predict OS for patients treated with transarterial chemoembolization following hepatic resection. The nomogram was internally validated with the bootstrapping method. The predictive performance of nomogram was assessed by Harrell's concordance index (C-index), calibration plot and time-dependent receiver operating characteristic curves and compared with six other conventional HCC staging systems.
Multivariate Cox analysis identified that albumin, blood urea nitrogen, gamma-glutamyl transpeptidase to platelet ratio, platelet to lymphocyte ratio, macrovascular invasion and tumour number were the six independent prognostic factors correlated with OS in nomogram model. The C-index in the training cohort and validation cohort were 0.752 and 0.807 for predicting OS, which were higher than those of the six conventional HCC staging systems (0.563 to 0.715 for the training cohort and 0.458 to 0.571 for the validation cohort). The calibration plots showed good consistency between the nomogram prediction of OS and the actual observations of OS. Decision curve analyses indicated satisfactory clinical utility. With a total nomogram score of 196, patients were accurately classified into low-risk and high-risk groups. Furthermore, we have deployed the model into online calculators that can be accessed for free at https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/.
The nomogram achieved optimal individualized prognostication of OS in HCC patients who received conversion therapy, which could be a useful clinical tool to help guide postoperative personalized interventions and prognosis judgement.
不可切除肝细胞癌（HCC）患者接受转化治疗的疗效是临床关注的共同问题。
分析接受肝切除术联合经肝动脉化疗栓塞（TACE）转化治疗的不可切除 HCC 患者总生存（OS）的预后因素。
纳入符合纳入标准的 150 例患者，分为训练队列（n=120）和验证队列（n=30）。使用训练队列中的独立危险因素，构建预测接受肝切除术联合 TACE 治疗的不可切除 HCC 患者 OS 的列线图模型。采用 bootstrap 方法对列线图进行内部验证。采用 Harrell 一致性指数（C 指数）、校准图和时间依赖性接受者操作特征曲线评估列线图的预测性能，并与其他 6 种常用 HCC 分期系统进行比较。
多因素 Cox 分析确定白蛋白、血尿素氮、γ-谷氨酰转肽酶/血小板比值、血小板/淋巴细胞比值、大血管侵犯和肿瘤数目是列线图模型中与 OS 相关的 6 个独立预后因素。训练队列和验证队列中 OS 的 C 指数分别为 0.752 和 0.807，均高于其他 6 种常用 HCC 分期系统（训练队列为 0.5630.715，验证队列为 0.4580.571）。校准图显示 OS 的列线图预测与实际观察的 OS 之间具有良好的一致性。决策曲线分析表明该模型具有良好的临床实用性。以总列线图评分为 196 分，可准确地将患者分为低危和高危组。此外，我们已将该模型部署到在线计算器中，可在 https://ctmodelforunresectablehcc.shinyapps.io/DynNomapp/ 免费访问。
列线图实现了接受转化治疗的 HCC 患者 OS 的最佳个体化预后预测，可作为一种有用的临床工具，帮助指导术后个性化干预和预后判断。
