A Powerful Nomogram Based on the Novel D-Index to Predict Prognosis After Surgical Resection of Hepatocellular Carcinoma.
A Powerful Nomogram Based on the Novel D-Index to Predict Prognosis After Surgical Resection of Hepatocellular Carcinoma.
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DOI：
10.2147/cmar.s305253
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发表时间：
2021
影响因子：
3.3
通讯作者：
Bao XD
中科院分区：
文献类型：
--
作者：
Du X;Guo CN;Bao XD
传统的分期和评分系统，如肿瘤、淋巴结和转移;意大利肝癌计划;巴塞罗那临床肝癌;和Okuda未能预测切除的原发性肝细胞癌患者的总生存期（OS）。因此，我们的目的是建立一个新的D指数和诺模图，以提高预后的准确性。我们选择了2007年1月至2015年2月在温州医科大学附属第一医院接受肝切除术的396例患者。这些患者以7：3的比例随机分为训练组和验证组。我们使用训练集中的五个独立风险因素生成了诺模图，包括D指数（通过总胆红素×肿瘤大小/脂肪与肌肉面积之比0.5计算）。根据一致性指数，诺模图的预测性能在训练和验证队列中相似。诺模图显示了1年、3年和5年OS的最强预测能力，接收操作特征曲线下面积分别为0.8486、0.7785和0.752。两个队列的校准曲线均显示稳定的性能。Kaplan-Meier曲线分层有显著性意义（P < 0.001）。D指数的相关列线图显示了对原发性肝细胞癌患者OS的强大而准确的预测能力。
Conventional staging and scoring systems such as the Tumor, Node, and Metastasis; Cancer of the Liver Italian Program; Barcelona Clinic Liver Cancer; and Okuda have failed to predict overall survival (OS) in patients with resected primary hepatocellular carcinoma. Thus, we aimed to establish a novel D-index and nomogram to improve prognostic accuracy. We selected 396 patients who underwent liver resection between January 2007 and February 2015 at the First Affiliated Hospital of Wenzhou Medical University. These patients were randomly divided into the training and validation groups in a ratio of 7:3. We generated a nomogram using five independent risk factors, including the D-index (calculated by total bilirubin × tumor size/the ratio of fat-to-muscle area 0.5) in the training set. The predictive performance of the nomogram was similar in both the training and validation cohorts according to the concordance index. The nomogram demonstrated the strongest predictive power for 1-year, 3-year, and 5-year OS, with the area under the receiving operating characteristic curve being 0.8486, 0.7785, and 0.752, respectively. The calibration curves exhibited stable capabilities in both cohorts. The stratification of the Kaplan-Meier curve was significant (P < 0.001). The associated nomogram of the D-index demonstrated a powerful and accurate predictive ability for OS in patients with primary hepatocellular carcinoma.