Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Research Center for Biomedical Resources, Beijing You'an Hospital Capital Medical University, Beijing, China.
Front Immunol. 2024 Mar 27;15:1357496. doi: 10.3389/fimmu.2024.1357496. eCollection 2024.
Hepatitis B surface antigen (HBsAg) clearance is associated with improved long-term outcomes and reduced risk of complications. The aim of our study was to identify the effects of levels of HBsAg in HCC patients undergoing TACE and sequential ablation. In addition, we created a nomogram to predict the prognosis of HCC patients with high levels of HBsAg (≥1000U/L) after local treatment.
This study retrospectively evaluated 1008 HBV-HCC patients who underwent TACE combined with ablation at Beijing Youan Hospital and Beijing Ditan Hospital from January 2014 to December 2021, including 334 patients with low HBsAg levels and 674 patients with high HBsAg levels. The high HBsAg group was divided into the training cohort (N=385), internal validation cohort (N=168), and external validation cohort (N=121). The clinical and pathological features of patients were collected, and independent risk factors were identified using Lasso-Cox regression analysis for developing a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves in the training and validation cohorts. Patients were classified into high-risk and low-risk groups based on the risk scores of the nomogram.
After PSM, mRFS was 28.4 months (22.1-34.7 months) and 21.9 months (18.5-25.4 months) in the low HBsAg level and high HBsAg level groups (P<0.001). The content of the nomogram includes age, BCLC stage, tumor size, globulin, GGT, and bile acids. The C-index (0.682, 0.666, and 0.740) and 1-, 3-, and 5-year AUCs of the training, internal validation, and external validation cohorts proved good discrimination of the nomogram. Calibration curves and DCA curves suggested accuracy and net clinical benefit rates. The nomogram enabled to classification of patients with high HBsAg levels into low-risk and high-risk groups according to the risk of recurrence. There was a statistically significant difference in RFS between the two groups in the training, internal validation, and external validation cohorts (P<0.001).
High levels of HBsAg were associated with tumor progression. The nomogram developed and validated in the study had good predictive ability for patients with high HBsAg levels.
乙肝表面抗原（HBsAg）清除与长期预后改善和并发症风险降低相关。本研究的目的是确定 HBsAg 水平对接受 TACE 序贯消融治疗的 HCC 患者的影响。此外，我们创建了一个列线图来预测局部治疗后 HBsAg 水平较高（≥1000U/L）的 HCC 患者的预后。
本研究回顾性分析了 2014 年 1 月至 2021 年 12 月在北京佑安医院和北京地坛医院接受 TACE 联合消融治疗的 1008 例 HBV-HCC 患者，包括低 HBsAg 水平组 334 例和高 HBsAg 水平组 674 例。高 HBsAg 组分为训练队列（N=385）、内部验证队列（N=168）和外部验证队列（N=121）。收集患者的临床和病理特征，采用 Lasso-Cox 回归分析确定独立危险因素，建立列线图。在训练和验证队列中，通过 C 指数、受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）曲线评估列线图的性能。根据列线图的风险评分将患者分为高危和低危组。
PSM 后，低 HBsAg 水平组和高 HBsAg 水平组的 mRFS 分别为 28.4 个月（22.1-34.7 个月）和 21.9 个月（18.5-25.4 个月）（P<0.001）。列线图的内容包括年龄、BCLC 分期、肿瘤大小、球蛋白、GGT 和胆汁酸。训练、内部验证和外部验证队列的 C 指数（0.682、0.666 和 0.740）以及 1、3 和 5 年 AUC 证明了列线图的良好区分能力。校准曲线和 DCA 曲线表明了准确性和净临床获益率。该列线图能够根据复发风险将高 HBsAg 水平的患者分为低危和高危组。在训练、内部验证和外部验证队列中，两组间的 RFS 存在统计学差异（P<0.001）。
高 HBsAg 水平与肿瘤进展相关。本研究中开发和验证的列线图对 HBsAg 水平较高的患者具有良好的预测能力。
