Prognostic Nomograms for Pre- and Postoperative Predictions of Long-Term Survival for Patients Who Underwent Liver Resection for Huge Hepatocellular Carcinoma
Prognostic Nomograms for Pre- and Postoperative Predictions of Long-Term Survival for Patients Who Underwent Liver Resection for Huge Hepatocellular Carcinoma
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DOI：
10.1016/j.jamcollsurg.2015.08.003
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发表时间：
2015-11-01
影响因子：
5.2
通讯作者：
Shen, Feng
中科院分区：
文献类型：
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作者：
Li, Yuntong;Xia, Yong;Shen, Feng
背景：肝切除术是肝癌（HCC，直径>= 10 cm）患者的有效治疗方法。本研究旨在开发用于预测这些患者术前和术后总生存期（OS）的线图。研究设计：2008年1月至2009年12月，在东方肝胆外科医院（EHBH）连续有464例患者因巨大HCC接受肝切除术。他们被收集并分为培训队列（n = 310）和内部验证队列（n = 154）。另外，2008年1月至2010年4月在福建医科大学（FMU）接受手术的90例患者作为外部验证队列。观察手术发生率、死亡率、复发时间及总生存率。根据术前和术后获得的数据分别制定了两种预后图。采用一致性指数（C-index）、校准曲线和验证研究来衡量模型的判别和预测精度。结果：EHBH患者术后4年肿瘤复发率为79.0%，OS为41.2%，FMU患者术后4年肿瘤复发率为78.8%，OS为37.6%。利用术前和术后数据进行多变量分析，将OS的独立预测因子分别纳入2个模态图中。在训练队列中，4年术后生存概率的校准曲线拟合良好。术前和术后nomogram预测OS的c -index分别为0.75 （95% CI 0.72 ~ 0.78）和0.78 （95% CI 0.75 ~ 0.81）。内部和外部验证研究最优地支持了这些结果。结论：两种形态图能够准确预测肝切除术后巨大HCC患者的长期生存。(C) 2015年由美国外科医师学会发布
BACKGROUND: Liver resection is an effective treatment in select patients with huge hepatocellular carcinoma (HCC, diameter >= 10 cm). This study aimed to develop nomograms for pre- and postoperative predictions of overall survival (OS) for these patients.STUDY DESIGN: There were 464 consecutive patients who underwent liver resection for huge HCC at the Eastern Hepatobiliary Surgery Hospital (EHBH) between January 2008 and December 2009. They were collected and divided into a training cohort (n = 310) and an internal validation cohort (n = 154). Another 90 patients who were operated on at the Fujian Medical University (FMU) between January 2008 and April 2010 served as an external validation cohort. The surgical morbidity, mortality, time to recurrence, and OS were observed. Two prognostic nomograms were developed based separately on the data obtained before and after surgery. Discrimination and predictive accuracy of the models were measured using concordance index (C-index), calibration curves, and validation study.RESULTS: The postoperative 4-year tumor recurrence and OS rates were, respectively, 79.0% and 41.2% in the patients from the EHBH and 78.8% and 37.6% in those from the FMU. Independent predictors of OS on multivariable analysis using pre-and postoperative data were respectively incorporated into the 2 nomograms. In the training cohort, calibration curves for the probability of 4-year postoperative survival fitted well. The C-indexes of the pre-and postoperative nomograms in predicting OS were 0.75 (95% CI 0.72 to 0.78) and 0.78 (95% CI 0.75 to 0.81), respectively. The internal and external validation studies optimally supported these results.CONCLUSIONS: The 2 nomograms achieved accurate pre- or postoperative predictions of long-term survival for patients with huge HCC after liver resection. (C) 2015 by the American College of Surgeons