摘要
目的 建立术前血清前白蛋白水平的预后诺模图,预测TACE治疗不可切除肝细胞癌(HCC)患者总体生存期(OS).方法 将2007年1月至2018年12月在苏州5家医疗中心接受TACE治疗的1 041例不可切除HCC患者分为训练队列(n=768)和验证队列(n=273).Cox回归分析影响HCC患者1、2、3年(OS)的独立因素.基于独立危险因素构建诺模图,并在内部测试序列进行了验证.通过C指数、接收器工作特性曲线下面积(AUC)、校准曲线和判决曲线分析(DCA)来评估诺模图的性能.结果 Cox回归分析显示,AFP、BCLC、HBV感染、肝内血管侵犯、肿瘤数目、前白蛋白、PS、肿瘤大小均为影响TACE治疗不可切除HCC患者OS的独立危险因素.诺模图中训练队列C指数为0.739(95％CI:0.719～0.759),验证队列C指数为0.715(95％CI:0.678～0.752).训练队列中1、2和3年OS的AUC分别为0.877、0.794、0.799;验证队列的1、2和3年OS的AUC分别为0.840、0.741、0.671.诺模图AUC均高于其他评分系统,显示该诺模图具有良好区分度.校准曲线提示该模型的预测结果与实际观测值之间存在良好的一致性.DCA显示该诺模图具有很高的潜在临床实用性.诺模图风险评分显示,低风险组的患者存活率显著高于高风险组.结论 基于术前前白蛋白水平的诺模图对TACE治疗不可切除HCC患者显示出良好的预测能力.
Abstract
Objective To establish a prognostic nomogram based on preoperative serum prealbumin levels for predicting overall survival(OS)in patients with unresectable hepatocellular carcinoma(HCC)treated with transcatheter arterial chemoembolization(TACE).Methods A total of 1 041 patients with unresectable HCC,who received TACE treatment at five medical centers in Suzhou city of China between January 2007 and December 2018,were divided into a training cohort(n=768)and a validation cohort(n=273).Cox regression analysis was used to analyzed the independent factors affecting one-,2-,and 3-year OS,based on which the nomogram was constructed,and validation of the nomogram was conducted in an internal test sequence.The performance of the nomogram was evaluated by concordance index(C-index),area under the receiver operating characteristic curve(AUC),calibration curve,and judgment curve analysis(DCA).Results COX regression analysis showed that AFP,BCLC,HBV,intrahepatic vascular invasion,number of tumors,PALB,PS,and tumor size were the independent risk factors affecting OS in patients with unresectable HCC treated with TACE.The C-index in the nomogram was 0.739(95％CI:0.719-0.759)for the training cohort and 0.715(95％CI:0.678-0.752)for the verification cohort.The AUCs of one-,2-,and 3-year OS in the training cohort were 0.877,0.794,and 0.799 respectively,which in the verification cohort were 0.840,0.741,and 0.671 respectively.The AUC-ROC values of the nomogram were higher than those of other traditional scoring systems,indicating that the nomogram had a good discriminatory power.The calibration curves demonstrated that a strong agreement existed between the predicted values of the nomogram and the actual observed values,and the DCA showed that the nomogram had high potential clinical utilization.The nomogram risk score revealed that the survival rate of patients in the low-risk group was significantly higher than that of patients in the high-risk group.Conclusion The nomogram based on preoperative serum prealbumin levels has excellent ability in predicting the prognosis of patients with unresectable HCC treated with TACE.
维普
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