Nomograms for prediction of long-term survival in elderly patients after partial hepatectomy for hepatocellular carcinoma
Nomograms for prediction of long-term survival in elderly patients after partial hepatectomy for hepatocellular carcinoma
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DOI：
10.1016/j.surg.2017.07.019
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发表时间：
2017-12-01
期刊：
影响因子：
3.8
通讯作者：
Shen, Feng
中科院分区：
文献类型：
--
作者：
Cheng, Zhangjun;Yang, Pinghua;Shen, Feng
背景肝部分切除术是治疗老年肝癌的重要手段。然而，对个别老年患者肝部分切除术后的长期预后的预测仍然缺乏。本研究旨在开发2个列线图来预测这些患者的术前或术后总生存期。方法。在2008年至2011年期间在东部肝胆外科医院接受肝细胞癌部分肝切除术的528例老年患者（年龄65岁）中，425例患者作为培训队列，以制定术前和术后列线图，其余103例患者组成验证队列。采用考克斯比例风险模型对肿瘤复发和总生存期进行单变量和多变量分析。采用一致性指数、校正曲线和Kaplan-Meier曲线对模型进行判别和校正。根据术前数据，总生存率的独立危险因素为年龄> 75岁、Charlson评分、甲胎蛋白>= 20 μ g/L、B病毒脱氧核糖核酸>= 10（4）IU/mL和肿瘤直径。根据术后数据，非解剖性肝切除术、肿瘤包膜缺失和微血管浸润是额外的独立风险因素。这些独立的预测因素分别纳入术前和术后列线图。2个列线图预测总生存期的一致性指数分别为0.70（95%可信区间，0.67-0.74）和0.72（0.69-0.78）。两种列线图均能准确预测1年、3年和5年总生存率，其预测性能得到最佳验证。提出的2个诺模图显示了良好的个体化预测性能的老年肝癌患者的肝部分切除术前后。
Background. Partial hepatectomy is an important treatment for elderly patients with hepatocellular carcinoma. However, prediction of long-term outcomes of an individual elderly patient after partial hepatectomy still is lacking. This study aimed to develop 2 nomograms to pre- or postoperatively predict overall survival for these patients.Methods. Of the 528 elderly patients (aged 65 years) who underwent partial hepatectomy for hepatocellular carcinoma at the Eastern Hepatobiliary Surgery Hospital between 2008 and 2011, 425 patients served as a training cohort to develop pre- and postoperative nomograms, and the remaining 103 patients comprised a validation cohort. The Cox proportional hazards model was used for univariate and multivariable analyses of tumor recurrence and overall survival. Discrimination and calibration of the models were measured using the concordance index, calibration plots, and Kaplan Meier curves.Results. Based on preoperative data, the independent risk factors of overall survival were age 75 years, Charlson score, alpha-fetoprotein >= 20 mu g/L, hepatitis B virus-deoxyribonucleic acid >= 10(4) IU/mL, and tumor diameter. Based on postoperative data, nonanatomic hepatectomy, absence of tumor encapsulation, and presence of microvascular invasion were additional independent risk factors. These independent predictors were incorporated into the pre- and postoperative nomograms, respectively. The concordance indexes of the 2 nomograms for overall survival prediction were 0.70 (95 % confidence interval, 0.67-0.74) and 0.72 (0.69-0.78), respectively. Both nomograms accurately predicted 1-, 3-, and 5-year overall survival probability, and their predictive performances were optimally validated.Conclusion. The proposed 2 nomograms showed good individualized predictive performance in elderly patients with hepatocellular carcinoma before and after partial hepatectomy.