Qiu Peng, Feng Yunxiang, Zhao Kai, Shi Yuanxin, Li Xiangyu, Deng Zhengdong, Wang Jianming
Department of Biliary and Pancreatic Surgery, Cancer Research Center Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Pediatric Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Heliyon. 2024 Sep 19;10(19):e38038. doi: 10.1016/j.heliyon.2024.e38038. eCollection 2024 Oct 15.
Bone metastasis considerably undermines the prognosis of advanced primary liver cancer patients. Though its impact is well-recognized, the clinical field still lacks robust predictive models that can accurately forecast patient outcomes and aid in treatment effectiveness evaluation. Addressing this gap is paramount for improving patient management and survival.
We conducted an extensive analysis using data from the SEER database (2010-2020). COX regression analysis was applied to identify prognostic factors for primary liver cancer with bone metastasis (PLCBM). Nomograms were developed and validated to predict survival outcomes in PLCBM patients. Additionally, propensity score matching and Kaplan-Meier survival analyses lent additional insight by dissecting the survival advantage conferred by various treatment strategies.
A total of 470 patients with PLCBM were included in our study. The median overall survival (OS) and cancer-specific survival (CSS) for these patients were both 5 months. We unveiled several independent prognosticators for OS and CSS, spanning demographic to therapeutic parameters like marital status, cancer grade, histological type, and treatments received. This discovery enabled the formulation of two novel nomograms-now verified to eclipse the predictive prowess of the traditional TNM staging system regarding discrimination and clinical utility. Additionally, propensity score matching analysis showed the effectiveness of surgeries, radiotherapy, and chemotherapy in improving OS and CSS outcomes for PLCBM patients.
Our investigation stands out by introducing pioneering nomograms for prognostic evaluation in PLCBM, a leap forward compared to existing tools. Far exceeding mere academic exercise, these nomograms hold immense clinical value, serving as a foundation for nuanced risk stratification systems and delivering dynamic, interactive guides, allowing healthcare professionals and patients to assess individual bone metastasis survival probabilities and personalize treatment selection.
骨转移严重影响晚期原发性肝癌患者的预后。尽管其影响已得到充分认识，但临床领域仍缺乏能够准确预测患者预后并有助于评估治疗效果的强大预测模型。填补这一空白对于改善患者管理和生存至关重要。
我们使用监测、流行病学和最终结果（SEER）数据库（2010 - 2020年）的数据进行了广泛分析。应用COX回归分析来确定原发性肝癌骨转移（PLCBM）的预后因素。开发并验证了列线图以预测PLCBM患者的生存结果。此外，倾向评分匹配和Kaplan - Meier生存分析通过剖析各种治疗策略所带来的生存优势提供了更多见解。
我们的研究共纳入470例PLCBM患者。这些患者的中位总生存期（OS）和癌症特异性生存期（CSS）均为5个月。我们发现了几个OS和CSS的独立预后因素，涵盖从人口统计学特征到治疗参数，如婚姻状况、癌症分级、组织学类型和接受的治疗等。这一发现促成了两个新列线图的制定，现已证实这两个列线图在辨别能力和临床实用性方面优于传统的TNM分期系统。此外，倾向评分匹配分析显示手术、放疗和化疗对改善PLCBM患者的OS和CSS结果有效。
我们的研究通过引入用于PLCBM预后评估的开创性列线图脱颖而出，与现有工具相比向前迈进了一步。这些列线图远非仅仅是学术研究，具有巨大的临床价值，为细致入微的风险分层系统奠定基础，并提供动态、交互式指南，使医疗专业人员和患者能够评估个体骨转移的生存概率并个性化治疗选择。
