基于免疫相关评分预测肝细胞癌患者的预后。
Prediction of prognosis of patients with hepatocellular carcinoma based on immune-related score.
机构信息
General Surgery Department, Baoan Central Hospital, The Fifth Affiliated Hospital of Shen Zhen University, Xixiang Street, Bao 'an District, Shenzhen, 518000, Guangdong, PR China.
Department of Colorectal Surgery, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, 530000, PR China.
出版信息
Asian J Surg. 2024 Jan;47(1):310-319. doi: 10.1016/j.asjsur.2023.08.175. Epub 2023 Sep 4.
BACKGROUND
Immune-related scores are currently used for prognostic evaluation and as an immunotherapy reference in various cancers. However, the relationship between immune-related score and hepatocellular carcinoma (HCC) prognosis has not yet been investigated. This study aimed to explore the clinical application value of immune-related score for predicting HCC prognosis-related indicators including disease-free survival (DFS) and overall survival (OS), and to construct a clinical nomogram prediction model related to verification.
METHODS
This study included 284 HCC patients who were selected from the Cancer Genome Atlas (TCGA) database and linked to the immune-related score downloaded from the public platform. A Cox proportional hazards regression model was used to estimate the adjusted risk ratio, and a nomogram was constructed based on multivariate analysis results and clinical significance. The model was internally verified by bootstrap. The performance of the prediction model was evaluated using the C-index and calibration curves.
RESULTS
Patients were divided into three subgroups according to the immune-related score level. Compared with patients in the low immune-related score group, the DFS of patients in the medium and high immune-related score groups was significantly prolonged (HR: 0.53, 95% CI: 0.32-0.87; HR: 0.37, 95% CI: 0.21-0.63, respectively). The OS of patients in the medium and high immune-related score groups was also significantly prolonged (HR: 0.43, 95% CI: 0.20-0.95, p = 0.038; HR: 0.29, 95% CI: 0.14-0.58, p < 0.001, respectively). The C-indexes for predicting DFS and OS were 0.687 (95% CI: 0.665-0.700) and 0.743 (95% CI: 0.709-0.776), respectively. The calibration curves of 3-year and 5-year DFS and OS showed that the results predicted by the nomogram were in good agreement with the actual observations.
CONCLUSIONS
Moderate/high-grade immune-related score was significantly associated with better DFS and OS in HCC patients. In addition, a nomogram for prognosis estimation can help clinicians predict the survival status of patients.
背景
免疫相关评分目前用于各种癌症的预后评估和免疫治疗参考。然而，免疫相关评分与肝细胞癌（HCC）预后之间的关系尚未得到研究。本研究旨在探讨免疫相关评分预测 HCC 无病生存（DFS）和总生存（OS）等预后指标的临床应用价值，并构建相关验证的临床列线图预测模型。
方法
本研究纳入了 284 例来自癌症基因组图谱（TCGA）数据库的 HCC 患者，并与从公共平台下载的免疫相关评分相关联。采用 Cox 比例风险回归模型估计调整后的风险比，并基于多变量分析结果和临床意义构建列线图预测模型。通过自举法对内进行验证。使用 C 指数和校准曲线评估预测模型的性能。
结果
根据免疫相关评分水平将患者分为三组。与低免疫相关评分组相比，中、高免疫相关评分组的 DFS 明显延长（HR：0.53，95%CI：0.32-0.87；HR：0.37，95%CI：0.21-0.63）。中、高免疫相关评分组的 OS 也明显延长（HR：0.43，95%CI：0.20-0.95，p=0.038；HR：0.29，95%CI：0.14-0.58，p<0.001）。预测 DFS 和 OS 的 C 指数分别为 0.687（95%CI：0.665-0.700）和 0.743（95%CI：0.709-0.776）。3 年和 5 年 DFS 和 OS 的校准曲线表明，列线图预测结果与实际观察结果吻合良好。
结论
中/高等级免疫相关评分与 HCC 患者更好的 DFS 和 OS 显著相关。此外，预后估计的列线图可帮助临床医生预测患者的生存状态。
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