A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma
A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma
复制标题
一种预测不可切除肝细胞癌经动脉化疗栓塞发生难治性风险的新型预处理模型
DOI：
10.7150/jca.44847
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Yin, Xin
中科院分区：
文献类型：
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作者：
Hu, Keshu;Lu, Shenxin;Yin, Xin
背景与目的：肝细胞癌治疗过程中普遍存在肝动脉化疗栓塞无效的情况，这是一个棘手的问题，可能会影响预后。我们的目标是建立一个治疗前模型来识别难治性高风险的患者。方法：回顾性分析2010年至2016年在复旦大学附属中山医院接受过至少两次经动脉化疗栓塞术的初治患者824例。这些患者被随机分配到训练队列和验证队列中。使用逻辑回归和列线图根据临床和放射学变量建立治疗前评分模型。还评估了模型的辨别力和校准能力。结果：Logistic 回归确定血管化模式、ALBI 等级、血清甲胎蛋白水平、血清 γ-谷氨酰转肽酶水平和主要肿瘤大小是与不应性相关的关键参数。使用这些变量建立 p-TACE 模型（风险评分范围：0-19.5）。根据评分将患者分为六个风险亚组（<4、≥4、≥7、≥10、≥13、≥16）。由接受者操作特征曲线下面积确定的辨别能力在训练队列中为 0.784（95% 置信区间：0.741-0.827），在验证队列中为 0.743（95% 置信区间：0.696-0.789）。此外，Hosmer-Lemeshow 检验证实了令人满意的校准，训练队列和验证队列中的 P 值为 0.767 和 0.913。结论：本研究提出了一种治疗前模型，用于识别经动脉化疗栓塞术后难治性高风险的患者，并为临床决策提供依据。
Background and aim: Refractoriness to transarterial chemoembolization is common during the therapeutic process of hepatocellular carcinoma, which is an intractable issue and may compromise the prognosis. We aim to establish a pre-treatment model to identify patients with high risks of refractoriness. Methods: From 2010 to 2016, 824 treatment-naive patients who had initially underwent at least two sessions of transarterial chemoembolization in Zhongshan Hospital, Fudan University were retrospectively enrolled. These patients were randomly allocated into a training cohort and a validation cohort. The pre-treatment scoring model was established based on the clinical and radiological variables using logistic regression and nomogram. The discrimination and calibration of the model were also evaluated. Results: Logistic regression identified vascularization pattern, ALBI grade, serum alpha-fetoprotein level, serum γ-glutamyl transpeptidase level and major tumor size as the key parameters related to refractoriness. The p-TACE model was established using these variables (risk score range: 0-19.5). Patients were divided into six risk subgroups based on their scores (<4, ≥4, ≥7, ≥10, ≥13, ≥16). The discriminative ability, as determined by the area under receiver operating characteristic curve was 0.784 (95% confidence interval: 0.741-0.827) in the training cohort and 0.743 (95% confidence interval: 0.696-0.789) in the validation cohort. Moreover, satisfactory calibration was confirmed by Hosmer-Lemeshow test with P values of 0.767 and 0.913 in the training cohort and validation cohort. Conclusions: This study presents a pre-treatment model to identify patients with high risks of refractoriness after transarterial chemoembolization and shed light on clinical decision making.