Xi Dong, Xu Mengying, Han Meiwen, Guan Qianting, Guo Qinghao, Yan Fangfei, Yao Junxia, Ning Qin
Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China.
J Hepatocell Carcinoma. 2023 Jun 16;10:909-920. doi: 10.2147/JHC.S412643. eCollection 2023.
A retrospective analysis of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) to identify risk factors was conducted, and a novel predictive nomogram model was constructed.
A total of 346 HCC patients who underwent TACE as initial treatment were retrospectively included, of which 208 were randomly allocated to the derivation cohort and 138 were allocated to the validation cohort. Progression-free survival (PFS) was used as the follow-up endpoint according to mRECIST. Kaplan‒Meier analysis and the Cox regression model screened out some indicators associated with short-term prognosis, and R language was further used to construct a nomogram model. The nomogram was compared with the classical BCLC staging system.
The independent predictors affecting PFS in HCC patients undergoing TACE included the following: 1. Baseline indicators: age (=0.013), albumin-bilirubin (ALBI) grade (grade 2 vs grade 1, =0.029; grade 3 vs grade 1, <0.001), and portal vein tumour thrombus (PVTT, <0.001); 2. Indicators at the 1-month follow-up: Neutrophil To Lymphocyte Ratio (NLR, =0.032) and changes in alpha-fetoprotein (AFP, <0.05) and des-γ-carboxy prothrombin (DCP, <0.001); and 3. Cumulative treatment numbers of TACE in 6 months (=0.007). In the derivation cohort, the calibration curve of the nomogram showed a high consistency between the predicted and actual PFS probability, and the nomogram outperformed the BCLC staging system (=0.004). This result was also confirmed in the validation cohort (=0.012).
The constructed nomogram was suggested to have good predictive efficacy and could be used as a complementary assessment to predict the survival and prognosis of HCC patients treated with TACE.
对接受经动脉化疗栓塞术（TACE）治疗的肝细胞癌（HCC）患者进行回顾性分析以确定危险因素，并构建一种新型预测列线图模型。
回顾性纳入总共346例接受TACE作为初始治疗的HCC患者，其中208例被随机分配至推导队列，138例被分配至验证队列。根据改良RECIST标准，将无进展生存期（PFS）用作随访终点。采用Kaplan-Meier分析和Cox回归模型筛选出一些与短期预后相关的指标，并进一步使用R语言构建列线图模型。将该列线图与经典的BCLC分期系统进行比较。
影响接受TACE治疗的HCC患者PFS的独立预测因素包括以下几点：1. 基线指标：年龄（=0.013）、白蛋白-胆红素（ALBI）分级（2级与1级相比，=0.029；3级与1级相比，<0.001）以及门静脉癌栓（PVTT，<0.001）；2. 随访1个月时的指标：中性粒细胞与淋巴细胞比值（NLR，=0.032）以及甲胎蛋白（AFP）变化（<0.05）和异常凝血酶原（DCP，<0.001）；3. 6个月内TACE的累积治疗次数（=0.007）。在推导队列中，列线图的校准曲线显示预测的和实际的PFS概率之间具有高度一致性，并且该列线图优于BCLC分期系统（=0.004）。这一结果在验证队列中也得到了证实（=0.012）。
所构建的列线图被认为具有良好的预测效能，可作为一种补充评估方法用于预测接受TACE治疗的HCC患者的生存和预后。
