Nomogram of the Barcelona Clinic Liver Cancer system for individual prognostic prediction in hepatocellular carcinoma
Nomogram of the Barcelona Clinic Liver Cancer system for individual prognostic prediction in hepatocellular carcinoma
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DOI：
10.1111/liv.13114
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发表时间：
2016-10-01
影响因子：
6.7
通讯作者：
Huo, Teh-Ia
中科院分区：
文献类型：
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作者：
Hsu, Chia-Yang;Liu, Po-Hong;Huo, Teh-Ia
背景与目的巴塞罗那临床肝癌(BCLC)分期系统对单个患者的预测准确性尚不清楚。本研究旨在建立基于BCLC系统的预测肝细胞癌患者个体化生存的诺模图。方法将3179例患者随机分为派生组(n=2119)和验证组(n=1060)。多变量Cox比例风险模型被用来生成肿瘤负担、肝硬变和绩效状态(PS)的诺模图。结果用Cox模型的Beta系数为不同的肿瘤负荷、Child-Turcotte-Pugh分级和PS评分分配诺模图的点数。建立了0~26分的标准图，计算了3年和5年的预测生存率。衍生集的一致性指数为0.766(95%可信区间：0.686-0.838)；验证集的一致性指数为0.775(95%可信区间：0.607-0.909)。在衍生组和验证组中，校准图都接近BCLC 0-C期患者3年和5年生存预测的45度线。对于BCLC D期患者，两组的校准曲线在3年和5年预测中都偏离了45度线。结论本研究为BCLC系统的预后能力提供了定量证据。这一简单易用的诺模图可以准确地预测除BCLC D期患者外，个别肝细胞癌患者3年和5年的生存期。
Background & AimsThe predictive accuracy of the Barcelona Clinic Liver Cancer (BCLC) staging system on a single patient is not clear. This study aimed to develop a nomogram to predict individualized survival of patients with hepatocellular carcinoma (HCC) based on the BCLC system.MethodsA total of 3179 patients were randomly grouped into derivation (n = 2119) and validation (n = 1060) sets. The multivariate Cox proportional hazards model was used to generate the nomogram from tumour burden, cirrhosis and performance status (PS). The performance of the nomogram was evaluated by concordance indices and calibration tests.ResultsBeta coefficients from the Cox model were used to assign nomogram points to different degrees of tumour burden, Child-Turcotte-Pugh classification and PS. A nomogram with a scale of 0-26 was developed and the predicted survival rates at 3 and 5 years were calculated. The derivation set had a concordance index of 0.766 (95% confidence interval [CI]: 0.686-0.838); and the validation set showed a concordance index of 0.775 (95% CI: 0.607-0.909). The calibration plots were close to the 45-degree line for 3- and 5-year survival prediction of BCLC stages 0-C patients in both derivation and validation groups. For BCLC stage D patients, calibration plots in both groups showed deviation from the 45-degree line for 3- and 5-year prediction.ConclusionsThis study provides quantitative evidence to support the prognostic ability of BCLC system. This straightforward and easy-to-use nomogram may accurately predict the survival at 3 and 5 years for individual HCC patient except for BCLC stage D patients.