Wu Zhen-Ying, Li Han, Chen Jia-Li, Su Ke, Weng Mei-Ling, Han Yun-Wei
Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Department of Oncology, Pangang Group General Hospital, Panzhihua 617000, Sichuan Province, China.
World J Gastrointest Oncol. 2024 Dec 15;16(12):4650-4662. doi: 10.4251/wjgo.v16.i12.4650.
The development of tumor is closely linked to inflammation. Therefore, targeting molecules involved in inflammation may be effective in predicting cancer prognosis. Transarterial chemoembolization (TACE) holds significant therapeutic significance in addressing hepatocellular carcinoma (HCC). At present, no studies have evaluated the predictive value of γ-glutamyl transferase to albumin ratio (GAR) on the prognosis of HCC undergoing TACE.
To explore the potential prognostic significance of the GAR in individuals undergoing TACE for HCC.
A total of 1231 patients from seven hospitals in China were randomized into a training cohort ( = 862) and a validation cohort ( = 369). To establish independent prognostic factors for overall survival (OS), we utilized multivariate and univariate Cox regression models. The best cut-off value of the GAR was determined with the X-tile software, with OS as the basis. Validations were performed using dual therapy cohort and triple therapy cohort.
X-tile software revealed a GAR threshold of 4.75 as optimal. Both pre- and post-propensity score matching analyses demonstrated that the median OS in the low-GAR group (< 4.75) was notably longer compared to the high-GAR group (≥ 4.75), showing results of 26.9 9.8 months ( < 0.001) initially, and 18.1 11.3 months ( < 0.001) after match. Furthermore, multivariate analysis identified GAR ≥ 4.75 as an independent prognostic factor ( < 0.001). The receiver operating characteristic curves for the nomogram showed area under receiver operating characteristic curves of 0.741, 0.747, and 0.708 for predicting 1-, 2-, and 3-year survival, respectively. Consistent findings were reiterated in the two cohorts involving TACE in combination with targeted therapy and TACE in combination with targeted therapy and immunotherapy. Calibration curve and decision curve analyses substantiated the model's relatively robust predictive capabilities.
Our study validates the effective prognostic capacity of the GAR-based nomogram for HCC patients undergoing TACE or TACE in combination with systemic therapy.
肿瘤的发展与炎症密切相关。因此，针对参与炎症的分子可能有助于预测癌症预后。经动脉化疗栓塞术（TACE）在治疗肝细胞癌（HCC）方面具有重要的治疗意义。目前，尚无研究评估γ-谷氨酰转移酶与白蛋白比值（GAR）对接受TACE治疗的HCC患者预后的预测价值。
探讨GAR在接受TACE治疗的HCC患者中的潜在预后意义。
来自中国七家医院的1231例患者被随机分为训练队列（n = 862）和验证队列（n = 369）。为了确定总生存期（OS）的独立预后因素，我们使用了多变量和单变量Cox回归模型。以OS为基础，使用X-tile软件确定GAR的最佳截断值。在双重治疗队列和三重治疗队列中进行验证。
X-tile软件显示GAR阈值为4.75时最佳。倾向评分匹配前后的分析均表明，低GAR组（<4.75）的中位OS明显长于高GAR组（≥4.75），最初结果为26.9±9.8个月（P<0.001），匹配后为18.1±11.3个月（P<0.001）。此外，多变量分析确定GAR≥4.75为独立预后因素（P<0.001）。列线图的受试者工作特征曲线预测1年、2年和3年生存率的曲线下面积分别为0.741、0.747和0.708。在涉及TACE联合靶向治疗以及TACE联合靶向治疗和免疫治疗的两个队列中也得到了一致的结果。校准曲线和决策曲线分析证实了该模型具有相对较强的预测能力。
我们的研究验证了基于GAR的列线图对接受TACE或TACE联合全身治疗的HCC患者具有有效的预后评估能力。
