Ji Kun, Niu Jiahua, Zhang Cong, Shi Yang, Liang Zhiying, Wang Zilin, Xu Tiantian, Cao Shoujin, Zhou Guanhui, Cao Yunbo, Zheng Yan, Zhu Jinghua, Li Zhen, Ai Jing, Chen Feng, Jing Li
Hepatobiliary and Pancreatic Interventional Treatment Center, Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Center of Interventional Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, China; Department of Radiology, The First People's Hospital of Kashi Area, Kashi, Xinjiang Uygur Autonomous Region, China.
Acad Radiol. 2025 Feb;32(2):776-786. doi: 10.1016/j.acra.2024.08.032. Epub 2024 Aug 26.
The optimal prognostic assessment for patients with hepatocellular carcinoma (HCC) after drug-eluting bead transarterial chemoembolization (DEB-TACE) remains unclear. This study aimed to propose a novel staging system in comparison with the current staging systems for HCC following DEB-TACE.
From four centers, patients with HCC undergoing DEB-TACE as the initial therapy were retrospectively included and classified into training and validation sets. Multivariable regression was used to determine the independent prognostic factors in the training set. A novel staging system incorporating the independent factors was proposed and externally validated in terms of discrimination and calibration compared to other staging systems in both sets.
The training and validation sets included 335 and 99 patients, respectively. Multivariable regression revealed independent factors including alpha-fetoprotein level, aspartate aminotransferase to lymphocyte count ratio index, maximum tumor diameter, Child-Pugh class, and portal vein invasion. The novel prognostic staging system, named PADCA, was proposed and outperformed other staging systems with the highest C-index, area under the curve, Wald test value, clinical benefit, and the lowest Akaike information criterion in the training and validation sets.
The PADCA staging system has a superior prognostic predictive ability compared to the current staging systems. PADCA can assist clinicians in screening out the patients most likely to derive benefit from DEB-TACE and guiding the formulation of therapy and follow-up strategy.
药物洗脱微球经动脉化疗栓塞术（DEB-TACE）后肝细胞癌（HCC）患者的最佳预后评估仍不明确。本研究旨在提出一种新的分期系统，并与目前DEB-TACE术后HCC的分期系统进行比较。
回顾性纳入来自四个中心接受DEB-TACE作为初始治疗的HCC患者，并分为训练集和验证集。采用多变量回归分析确定训练集中的独立预后因素。提出了一种纳入独立因素的新分期系统，并在两组中与其他分期系统进行鉴别和校准方面的外部验证。
训练集和验证集分别包括335例和99例患者。多变量回归分析显示独立因素包括甲胎蛋白水平、天冬氨酸转氨酶与淋巴细胞计数比值指数、最大肿瘤直径、Child-Pugh分级和门静脉侵犯。提出了一种名为PADCA的新预后分期系统，在训练集和验证集中，其C指数、曲线下面积、Wald检验值、临床获益最高，Akaike信息准则最低，优于其他分期系统。
与目前的分期系统相比，PADCA分期系统具有更好的预后预测能力。PADCA可协助临床医生筛选出最可能从DEB-TACE中获益的患者，并指导治疗方案的制定和随访策略。
