Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization
Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization
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DOI：
10.1016/j.jhep.2015.02.034
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发表时间：
2015-07-01
影响因子：
25.7
通讯作者：
Lau, Wan-Yee
中科院分区：
文献类型：
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作者：
Xu, Li;Peng, Zhen-Wei;Lau, Wan-Yee
背景和目标：为建立一个有效的预后诺模图的肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）后。方法：诺模图的基础上获得的数据从2938例患者的回顾性研究中获得的TACE作为初始治疗2000年至2008年。通过使用从2011年1月至2011年12月在同一机构接受治疗的647例患者队列的前瞻性研究中获得的数据，将诺模图的预测准确性和区分能力与目前常用的7种HCC分期系统进行比较。额外的外部验证使用的数据集（n = 221）从另一个institution.Results：门静脉侵犯，肿瘤数量，肿瘤包膜，甲胎蛋白，天冬氨酸氨基转移酶，吲哚菁绿色保留在15分钟形成的诺模图的基础。诺模图的一致性指数（C-index）为0.755，明显优于美国癌症联合委员会第七版（0.612），巴塞罗那诊所肝癌系统（0.692）奥田系统（0.579），日本综合分期系统（0.637），肝癌意大利计划系统（0.683）、中文大学预后指数（0.637）和肝细胞癌研究与治疗组（0.577）（均P < 0.001）。预测生存概率的校准曲线显示诺模图与实际观察之间的良好一致性。这些发现得到了外部验证队列的支持。结论：提出的诺模图对TACE治疗后不能切除的HCC患者的预后有准确的预测。(C)2015年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: To establish an effective prognostic nomogram for patients with unresectable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).Methods: The nomogram was constructed based on data obtained from a retrospective study on 2938 patients who received TACE as an initial therapy from 2000 to 2008. The predictive accuracy and discriminative ability of the nomogram were compared with seven current commonly used staging systems on HCC by using data obtained from a prospective study on a cohort of 647 patients treated from January 2011 to December 2011 at the same institution. Additional external validation was performed using a data set (n = 221) from another institution.Results: Portal vein invasion, tumor number, tumor capsule, alpha fetoprotein, aspartate aminotransferase, and indocyanine green retention at 15 min formed the basis of the nomogram. The concordance index (C-index) of the nomogram was 0.755, which was significantly better than the American Joint Committee on Cancer seventh edition (0.612), the Barcelona Clinic Liver Cancer system (0.692), the Okuda system (0.579), the Japan Integrated Staging system (0.637), Cancer of the Liver Italian Program system (0.683), the Chinese University Prognostic Index (0.637) and the Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire (0.577) (p < 0.001 for all). The calibration curve for predicting probability of survival showed a good agreement between the nomogram and actual observation. The findings were supported by the external validation cohort. The nomogram gave better discrimination than the seven staging systems.Conclusions: The proposed nomogram gave accurate prognostic prediction in patients with unresectable HCC after treatment with TACE. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.