Liu Yuan-Yuan, Li Yue-Yue, Liu Yong-Shuai, Zhang Zong-Li, Gao Yan-Jing
Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China.
Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China.
Front Oncol. 2024 Jun 28;14:1404799. doi: 10.3389/fonc.2024.1404799. eCollection 2024.
Our study aimed to develop a nomogram incorporating cytokeratin fragment antigen 21-1 (CYFRA21-1) to assist in differentiating between patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).
A total of 487 patients who were diagnosed with ICC and HCC at Qilu Hospital of Shandong University were included in this study. The patients were divided into a training cohort and a validation cohort based on whether the data collection was retrospective or prospective. Univariate and multivariate analyses were employed to select variables for the nomogram. The discrimination and calibration of the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plots. Decision curve analysis (DCA) was used to assess the nomogram's net benefits at various threshold probabilities.
Six variables, including CYFRA21-1, were incorporated to establish the nomogram. Its satisfactory discriminative ability was indicated by the AUC (0.972 for the training cohort, 0.994 for the validation cohort), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) values. The Hosmer-Lemeshow test and the calibration plots demonstrated favorable consistency between the nomogram predictions and the actual observations. Moreover, DCA revealed the clinical utility and superior discriminative ability of the nomogram compared to the model without CYFRA21-1 and the model consisting of the logarithm of alpha-fetoprotein (Log AFP) and the logarithm of carbohydrate antigen 19-9 (Log CA19-9). Additionally, the AUC values suggested that the discriminative ability of Log CYFRA21-1 was greater than that of the other variables used as diagnostic biomarkers.
This study developed and validated a nomogram including CYFRA21-1, which can aid clinicians in the differential diagnosis of ICC and HCC patients.
我们的研究旨在开发一种包含细胞角蛋白片段抗原21-1（CYFRA21-1）的列线图，以协助鉴别肝内胆管癌（ICC）和肝细胞癌（HCC）患者。
本研究纳入了山东大学齐鲁医院诊断为ICC和HCC的487例患者。根据数据收集是回顾性还是前瞻性，将患者分为训练队列和验证队列。采用单因素和多因素分析为列线图选择变量。使用受试者操作特征曲线（AUC）下面积和校准图评估列线图的辨别力和校准度。决策曲线分析（DCA）用于评估列线图在不同阈值概率下的净效益。
纳入了包括CYFRA21-1在内的6个变量来建立列线图。AUC（训练队列中为0.972，验证队列中为0.994）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）表明其具有令人满意的辨别能力。Hosmer-Lemeshow检验和校准图显示列线图预测与实际观察结果之间具有良好的一致性。此外，DCA显示与不含CYFRA21-1的模型以及由甲胎蛋白对数（Log AFP）和糖类抗原19-9对数（Log CA19-9）组成的模型相比，列线图具有临床实用性和更高的辨别能力。此外，AUC值表明Log CYFRA21-1的辨别能力大于用作诊断生物标志物的其他变量。
本研究开发并验证了一种包含CYFRA21-1的列线图，可帮助临床医生对ICC和HCC患者进行鉴别诊断。
