Wang Xinxin, Yu Yanyan, Tao Yuqing, Wang Yueqi, Zhang Chunhui, Cui Yali, Zhou Yang
Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China.
Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China.
J Hepatocell Carcinoma. 2023 Dec 21;10:2323-2335. doi: 10.2147/JHC.S434955. eCollection 2023.
This study aims to identify independent risk factors for ultra-early recurrence in patients with early solitary hepatocellular carcinoma (HCC) and develop an individualized predictive nomogram for ultra-early recurrence.
A total of 332 patients with early solitary HCC who underwent curative liver resection at our hospital from January 2015 to May 2021 were included in this study. Based on the patients' recurrence status at 6 months, they were divided into the non-ultra-early recurrence group and the ultra-early recurrence group. Univariate and multivariate Cox regression analyses were used to construct the nomogram, and internal validation of its performance was performed using calibration plots with bootstrapping.
Among the 332 patients with early solitary HCC, 39 (11.7%) experienced ultra-early recurrence. Tumor morphology, age > 46 years, AFP > 332.4 ng/mL, GGT > 51.2 U/L, ALP > 126 U/L, PT > 12.8 s, and satellite nodules were identified as independent prognostic factors for ultra-early recurrence in patients with early solitary HCC and were incorporated into the final predictive nomogram. The C-index of the nomogram and bootstrap resampling were 0.842 and 0.815, respectively. The calibration plot demonstrated good agreement between the predicted and observed probabilities of ultra-early recurrence, and DCA indicated the favorable clinical utility of the nomogram. Additionally, AFP > 332.4 ng/mL, AST > 35 U/L, GGT > 51.2 U/L, ALP > 126 U/L, tumor morphology, tumor size, satellite nodules, and intratumoral hemorrhage were identified as risk factors for overall survival in patients with early solitary HCC.
Our study establishes a nomogram for predicting the postoperative ultra-early recurrence status in patients with early solitary HCC, which provides valuable supplementary decision-making information for clinical decision-makers and guides the selection of the most appropriate treatment strategy.
本研究旨在确定早期孤立性肝细胞癌（HCC）患者超早期复发的独立危险因素，并开发一种用于预测超早期复发的个体化预测列线图。
本研究纳入了2015年1月至2021年5月在我院接受根治性肝切除术的332例早期孤立性HCC患者。根据患者6个月时的复发状态，将其分为非超早期复发组和超早期复发组。采用单因素和多因素Cox回归分析构建列线图，并使用自抽样校准图对其性能进行内部验证。
在332例早期孤立性HCC患者中，39例（11.7%）发生超早期复发。肿瘤形态、年龄>46岁、甲胎蛋白（AFP）>332.4 ng/mL、γ-谷氨酰转移酶（GGT）>51.2 U/L、碱性磷酸酶（ALP）>126 U/L、凝血酶原时间（PT）>12.8 s以及卫星结节被确定为早期孤立性HCC患者超早期复发的独立预后因素，并被纳入最终的预测列线图。列线图的C指数和自抽样重采样分别为0.842和0.815。校准图显示超早期复发的预测概率与观察概率之间具有良好的一致性，决策曲线分析（DCA）表明列线图具有良好的临床实用性。此外，AFP>332.4 ng/mL、天门冬氨酸氨基转移酶（AST）>35 U/L、GGT>51.2 U/L、ALP>126 U/L、肿瘤形态、肿瘤大小、卫星结节以及瘤内出血被确定为早期孤立性HCC患者总生存的危险因素。
我们的研究建立了一种用于预测早期孤立性HCC患者术后超早期复发状态的列线图，为临床决策者提供了有价值的辅助决策信息，并指导选择最合适的治疗策略。
