Huang Guizhong, Xi Pu, Yao Zehui, Zhao Chongyu, Li Xiaohui, Lin Xiaojun
Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
Heliyon. 2024 Jul 2;10(13):e33931. doi: 10.1016/j.heliyon.2024.e33931. eCollection 2024 Jul 15.
Conditional survival analysis can serve as a dynamic prognostic metric, which helps to estimate the real-time survival probability over time. The present study conducted a conditional recurrence-free survival (CRFS) analysis for locally advanced intrahepatic cholangiocarcinoma (ICC) after R0 hepatectomy from an inflammatory-nutritional perspective using the competing risk method.
We extracted the medical data of 164 locally advanced ICC patients after R0 resection from Sun Yat-sen University Cancer Center. The calculation formula of the CRFS rate is CRFS(y/x) = RFS(y + x)/RFS(x). Univariable and multivariable COX regression analysis and competing risk analysis were conducted to identify RFS indicators.
Considering death before recurrence as a competing risk factor, the conditional RFS rates every 6 months gradually increased over time. The 24-month RFS rate increased from 29.2 % to 49.9 %, 68.5 %, and 85.1 % given 6, 12, and 18-month already recurrence-free survival, respectively. Both in multivariate COX regression analysis and competing risk analysis, tumor diameter and number, lymph node metastasis, aggregate systemic inflammation index score (AISI), and albumin-bilirubin score (ALBI) all remained significant. For both AISI and ALBI variables, the CRFS rates in the low-value set were higher than those of the high-value set.
Conditional RFS rates of locally advanced ICC after R0 hepatectomy dynamically increased over time, which contributed to reducing survivors' psychological distress and facilitating personalized follow-up schedules. In addition, a person's inflammatory and nutritional status significantly impact the recurrence risk. Oncologists should consider the role of inflammation-nutritional status when making decisions for patients with locally advanced ICC.
条件生存分析可作为一种动态预后指标，有助于估计随时间变化的实时生存概率。本研究从炎症 - 营养角度，采用竞争风险法对局部晚期肝内胆管癌（ICC）行R0肝切除术后进行无复发生存期（CRFS）分析。
我们从中山大学肿瘤防治中心提取了164例局部晚期ICC患者R0切除后的医疗数据。CRFS率的计算公式为CRFS(y/x) = RFS(y + x)/RFS(x)。进行单变量和多变量COX回归分析以及竞争风险分析以确定RFS指标。
将复发前死亡视为竞争风险因素，每6个月的条件RFS率随时间逐渐增加。在已无复发存活6、12和18个月的情况下，24个月的RFS率分别从29.2%增至49.9%、68.5%和85.1%。在多变量COX回归分析和竞争风险分析中，肿瘤直径和数量、淋巴结转移、全身炎症综合指数评分（AISI）以及白蛋白 - 胆红素评分（ALBI）均保持显著。对于AISI和ALBI变量，低值组的CRFS率高于高值组。
局部晚期ICC行R0肝切除术后的条件RFS率随时间动态增加，这有助于减轻幸存者的心理困扰并促进个性化随访计划。此外，个体的炎症和营养状况对复发风险有显著影响。肿瘤学家在为局部晚期ICC患者做决策时应考虑炎症 - 营养状况的作用。
