Tian Yuan, Wang Yaoqun, Wen Ningyuan, Lin Yixin, Liu Geng, Li Bei
Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2024 May 24;14:1395740. doi: 10.3389/fonc.2024.1395740. eCollection 2024.
BACKGROUND: Hepatocellular carcinoma (HCC) is one of the common causes of tumor death in elderly patients. However, there is a lack of individualized prognostic predictors for elderly patients with HCC after surgery. METHOD: We retrospectively analyzed HCC patients over 65 years old who underwent hepatectomy from 2015 to 2018, and randomly divided them into training cohort and validation cohort in a ratio of 3:1. Univariate Cox regression was used to screen the risk factors related to prognosis. Prognostic variables were further selected by least absolute shrinkage and selection operator regression model (LASSO) and multivariate Cox regression to identify the predictors of overall survival (OS) and disease-free survival (DFS). These indicators were then used to construct a predictive nomogram. The receiver operating characteristic curve (ROC curve), calibration curve, consistency index (C-index) and decision analysis curve (DCA) were used to test the predictive value of these independent prognostic indicators. RESULT: A total of 188 elderly HCC patients who underwent hepatectomy were enrolled in this study. The independent prognostic indicators of OS included albumin (ALB), cancer embolus, blood loss, viral hepatitis B, total bilirubin (TB), microvascular invasion, overweight, and major resection. The independent prognostic indicators of DFS included major resection, ALB, microvascular invasion, laparoscopic surgery, blood loss, TB, and pleural effusion. In the training cohort, the ROC curve showed that the predictive values of these indicators for OS and DFS were 0.827 and 0.739, respectively, while in the validation cohort, they were 0.798 and 0.694. The calibration curve nomogram exhibited good prediction for 1-year, 2-year, and 3-year OS and DFS. Moreover, the nomogram models exhibited superior performance compared to the T-staging suggested by C-index and DCA. CONCLUSION: The nomogram established in this study demonstrate commendable predictive efficacy for OS and DFS in elderly patients with HCC after hepatectomy.Core Tip: The purpose of this retrospective study is to screen the risk factors of survival and recurrence in elderly patients with HCC after hepatectomy. The nomogram included cancer embolus, viral hepatitis B, overweight, major resection, ALB, microvascular invasion, laparoscopic surgery, blood loss, TB, and pleural effusion as predictors. The calibration curve of this nomogram was good, indicating credible predictive value and clinical feasibility.
背景：肝细胞癌（HCC）是老年患者肿瘤死亡的常见原因之一。然而，目前缺乏针对老年HCC患者术后的个体化预后预测指标。 方法：我们回顾性分析了2015年至2018年期间接受肝切除术的65岁以上HCC患者，并将其按3:1的比例随机分为训练队列和验证队列。采用单因素Cox回归筛选与预后相关的危险因素，并通过最小绝对收缩和选择算子回归模型（LASSO）及多因素Cox回归进一步选择预后变量，以确定总生存期（OS）和无病生存期（DFS）的预测指标。然后利用这些指标构建预测列线图。采用受试者工作特征曲线（ROC曲线）、校准曲线、一致性指数（C指数）和决策分析曲线（DCA）来检验这些独立预后指标的预测价值。 结果：本研究共纳入188例接受肝切除术的老年HCC患者。OS的独立预后指标包括白蛋白（ALB）、癌栓、失血、乙型病毒性肝炎、总胆红素（TB）、微血管侵犯、超重和大范围肝切除术。DFS的独立预后指标包括大范围肝切除术、ALB、微血管侵犯、腹腔镜手术、失血、TB和胸腔积液。在训练队列中，ROC曲线显示这些指标对OS和DFS的预测值分别为0.827和0.739，而在验证队列中分别为0.798和0.694。校准曲线列线图对1年、2年和3年的OS和DFS显示出良好的预测效果。此外，与C指数和DCA所提示的T分期相比，列线图模型表现出更优的性能。 结论：本研究建立的列线图对老年HCC患者肝切除术后的OS和DFS显示出良好的预测效能。 核心提示：本回顾性研究旨在筛选老年HCC患者肝切除术后生存和复发的危险因素。列线图纳入癌栓、乙型病毒性肝炎、超重、大范围肝切除术、ALB、微血管侵犯、腹腔镜手术、失血、TB和胸腔积液作为预测指标。该列线图的校准曲线良好，提示具有可靠的预测价值和临床可行性。
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