A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy
A nomogram predicting the recurrence of hepatocellular carcinoma in patients after laparoscopic hepatectomy
复制标题
预测腹腔镜肝切除术后患者肝细胞癌复发的列线图
DOI：
10.1186/s40880-019-0404-6
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发表时间：
2019-10-11
影响因子：
16.2
通讯作者：
Zhou, Zhong-Guo
中科院分区：
文献类型：
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作者：
Pan, Yang-Xun;Chen, Jian-Cong;Zhou, Zhong-Guo
肝细胞癌（HCC）患者接受手术切除后5年复发率仍然很高（约60%）。随着腹腔镜肝切除术（LH）的发展，很少有研究比较LH与传统手术入路治疗肝癌的疗效。本研究的目的是建立一个诺模图来评估接受LH的肝癌患者复发的风险。方法收集了432例经病理诊断为肝癌、接受LH作为初始治疗且手术切缘> 1 cm的患者的临床数据。评估其临床病理特征对无复发生存期（RFS）的意义，基于此，使用训练队列（n= 324）构建列线图，并使用时间验证队列（n= 108）进行内部验证。（风险比[HR]，1.838;P= 0.044），肿瘤数量（HR，1.774;P= 0.003），癌栓（HR，2.356;P= 0.003），癌细胞分化（HR，0.745;P= 0.080），微血管肿瘤浸润（HR，1.673;P=0.007）被认为是训练队列中RFS的独立危险因素，并用于构建诺模图。使用列线图预测训练队列中RFS的C指数为0.786，高于第8版美国癌症联合委员会TNM分类（C指数，0.698）和巴塞罗那临床肝癌分期系统（C指数，0.632）。诺模图的预测和实际观测之间的高度一致性也证明了校准曲线。接受者工作特征曲线分析，这也证实了在验证队列相比，其他system.ConclusionsWe构建并验证了一个nomogram能够量化的风险复发后，初始LH为肝癌患者，这可以在临床上实施，以协助planification个人术后监测协议的预测效益RFS和更高的阈值概率的nomogram。
BackgroundPatients with hepatocellular carcinoma (HCC) undergoing surgical resection still have a high 5‐year recurrence rate (~ 60%). With the development of laparoscopic hepatectomy (LH), few studies have compared the efficacy between LH and traditional surgical approach on HCC. The objective of this study was to establish a nomogram to evaluate the risk of recurrence in HCC patients who underwent LH.MethodsThe clinical data of 432 patients, pathologically diagnosed with HCC, underwent LH as initial treatment and had surgical margin > 1 cm were collected. The significance of their clinicopathological features to recurrence‐free survival (RFS) was assessed, based on which a nomogram was constructed using a training cohort (n= 324) and was internally validated using a temporal validation cohort (n= 108).ResultsHepatitis B surface antigen (hazard ratio [HR], 1.838;P= 0.044), tumor number (HR, 1.774;P= 0.003), tumor thrombus (HR, 2.356;P= 0.003), cancer cell differentiation (HR, 0.745;P= 0.080), and microvascular tumor invasion (HR, 1.673;P=0.007) were found to be independent risk factors for RFS in the training cohort, and were used for constructing the nomogram. The C‐index for RFS prediction in the training cohort using the nomogram was 0.786, which was higher than that of the 8th edition of the American Joint Committee on Cancer TNM classification (C‐index, 0.698) and the Barcelona Clinic Liver Cancer staging system (C‐index, 0.632). A high consistency between the nomogram prediction and actual observation was also demonstrated by a calibration curve. An improved predictive benefit in RFS and higher threshold probability of the nomogram were determined by receiver operating characteristic curve analysis, which was also confirmed in the validation cohort compared to other systems.ConclusionsWe constructed and validated a nomogram able to quantify the risk of recurrence after initial LH for HCC patients, which can be clinically implemented in assisting the planification of individual postoperative surveillance protocols.