Development and validation of a nomogram for survival prediction in hepatocellular carcinoma after partial hepatectomy.
Development and validation of a nomogram for survival prediction in hepatocellular carcinoma after partial hepatectomy.
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DOI：
10.1186/s12893-023-01922-x
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发表时间：
2023-01-30
期刊：
影响因子：
1.9
通讯作者：
Jiang, Jianning
中科院分区：
文献类型：
--
作者：
Lu, Yang;Ren, Shuang;Jiang, Jianning
肝细胞癌（HCC）由于其高度异质性，即使在根治性切除后预后也很复杂。本研究旨在开发并验证一种预测肝癌患者肝部分切除术后预后的列线图。
我们利用监测、流行病学和最终结果（SEER）数据库提取肝癌患者的数据，并将其随机分为两组（训练组和验证组）。我们根据训练组的数据开发了预测模型，并使用单因素和多因素Cox回归分析评估预后因素。基于多因素Cox回归分析的结果构建了一个列线图，用于预测肝癌患者术后1年、3年和5年的生存概率。从区分度和校准度方面评估列线图的性能。为了验证该模型，在验证组中也对区分度和校准度进行了评估。进行决策曲线分析（DCA）以评估列线图的临床实用性。
研究共纳入890例因肝癌接受肝部分切除术的患者。训练组纳入628例患者，中位随访时间为39个月，随访期间1年、3年和5年生存率分别为95.4%、52.7%和25.8%。多因素Cox回归分析表明，分化程度、肿瘤大小、甲胎蛋白（AFP）和纤维化与肝癌患者肝部分切除术后的预后独立相关。该列线图具有中等区分度，C指数为0.705（95%置信区间为0.669 - 0.742），且校准良好。在验证组中也观察到类似的区分度，C指数为0.681（95%置信区间为0.625 - 0.737），且校准良好。决策曲线分析表明，该列线图可用于预测肝癌患者肝部分切除术后的预后。
所提出的列线图具有较高的预测性，且校准度和区分度适中，可能有助于以个体化方式管理肝癌患者肝部分切除术后的过程。
The prognosis for hepatocellular carcinoma (HCC) is complex due to its high level of heterogeneity, even after radical resection. This study was designed to develop and validate a prognostic nomogram for predicting the postoperative prognosis for HCC patients following partial hepatectomy. We extracted data on HCC patients and randomly divided them into two groups (primary and validation cohorts), using the Surveillance, Epidemiology and End Results (SEER) database. We developed the prediction model based on the data of the primary cohort and prognostic factors were evaluated using univariate and multivariate Cox regression analysis. A nomogram was constructed for predicting the 1-, 3-, and 5-year survival probability of HCC patients after surgery based on the results of the multivariate Cox regression analysis. The performance of the nomogram was evaluated in terms of its discrimination and calibration. To validated the model, discrimination and calibration were also evaluated in the validation cohort. Decision curve analysis (DCA) was performed to assess the clinical utility of the nomogram. A total of 890 patients who underwent partial hepatectomy for HCC were included in the study. The primary cohort enrolled 628 patients with a median follow-up time of 39 months, the 1-, 3-, and 5-year survival rate were 95.4%, 52.7% and 25.8% during follow-up. Multivariate Cox regression analysis showed that differentiation, tumor size, AFP and fibrosis were independently association with the prognosis of HCC patients after partial hepatectomy. The nomogram showed a moderate discrimination ith a C-index of 0.705 (95% CI 0.669 to 0.742), and good calibration. Similar discrimination with a C-index of 0.681 (95% CI 0.625 to 0.737), and calibration were also observed in the validation cohort. Decision curve analysis showed that the nomogram could be useful to predicting the prognosis in HCC patients following partial hepatectomy. The proposed nomogram is highly predictive and has moderate calibration and discrimination, potentially contributing to the process of managing HCC patients after partial hepatectomy in an individualized way.
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发表时间：
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期刊：
Lancet (London, England)
影响因子：
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