Yang Yong-Ping, Guo Cheng-Jun, Gu Zhao-Xuan, Hua Jun-Jie, Zhang Jia-Xuan, Shi Jian
Department of General Surgery, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China.
World J Gastrointest Oncol. 2023 Nov 15;15(11):1874-1890. doi: 10.4251/wjgo.v15.i11.1874.
The prognosis of many patients with distant metastatic hepatocellular carcinoma (HCC) improved after they survived for several months. Compared with traditional survival analysis, conditional survival (CS) which takes into account changes in survival risk could be used to describe dynamic survival probabilities.
To evaluate CS of distant metastatic HCC patients.
Patients diagnosed with distant metastatic HCC between 2010 and 2015 were extracted from the Surveillance, Epidemiology and End Results database. Univariate and multivariate Cox regression analysis were used to identify risk factors for overall survival (OS), while competing risk model was used to identify risk factors for cancer-specific survival (CSS). Six-month CS was used to calculate the probability of survival for an additional 6 mo at a specific time after initial diagnosis, and standardized difference (d) was used to evaluate the survival differences between subgroups. Nomograms were constructed to predict CS.
Positive α-fetoprotein expression, higher T stage (T3 and T4), N1 stage, non-primary site surgery, non-chemotherapy, non-radiotherapy, and lung metastasis were independent risk factors for actual OS and CSS through univariate and multivariate analysis. Actual survival rates decreased over time, while CS rates gradually increased. As for the 6-month CS, the survival difference caused by chemotherapy and radiotherapy gradually disappeared over time, and the survival difference caused by lung metastasis reversed. Moreover, the influence of age and gender on survival gradually appeared. Nomograms were fitted for patients who have lived for 2, 4 and 6 mo to predict 6-month conditional OS and CSS, respectively. The area under the curve (AUC) of nomograms for conditional OS decreased as time passed, and the AUC for conditional CSS gradually increased.
CS for distant metastatic HCC patients substantially increased over time. With dynamic risk factors, nomograms constructed at a specific time could predict more accurate survival rates.
许多远处转移性肝细胞癌（HCC）患者在存活数月后预后有所改善。与传统生存分析相比，考虑生存风险变化的条件生存（CS）可用于描述动态生存概率。
评估远处转移性HCC患者的条件生存情况。
从监测、流行病学和最终结果数据库中提取2010年至2015年诊断为远处转移性HCC的患者。采用单因素和多因素Cox回归分析确定总生存（OS）的危险因素，同时采用竞争风险模型确定癌症特异性生存（CSS）的危险因素。使用6个月条件生存来计算初次诊断后特定时间再存活6个月的概率，并使用标准化差异（d）评估亚组间的生存差异。构建列线图以预测条件生存。
通过单因素和多因素分析，甲胎蛋白表达阳性、较高的T分期（T3和T4）、N1分期、非原发部位手术、未化疗、未放疗和肺转移是实际OS和CSS的独立危险因素。实际生存率随时间下降，而条件生存率逐渐上升。对于6个月条件生存，化疗和放疗引起的生存差异随时间逐渐消失，肺转移引起的生存差异逆转。此外，年龄和性别对生存的影响逐渐显现。为存活2、4和6个月的患者分别拟合列线图以预测6个月条件OS和CSS。条件OS列线图的曲线下面积（AUC）随时间推移而下降，条件CSS的AUC逐渐增加。
远处转移性HCC患者的条件生存随时间显著增加。利用动态危险因素，在特定时间构建的列线图可以预测更准确的生存率。
