A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma
A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma
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DOI：
10.1016/j.jamcollsurg.2007.07.031
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发表时间：
2008-02-01
影响因子：
5.2
通讯作者：
DeMatteo, Ronald P.
中科院分区：
文献类型：
--
作者：
Cho, Clifford S.;Gonen, Mithat;DeMatteo, Ronald P.
背景：预测肝细胞癌（HCC）切除术后的生存率仍然很困难。许多分期系统已被设计为风险分类的目的，我们试图确定最佳的分期系统，以预测术后survival.Study设计：1989年至2002年期间，在我们的机构进行原发性肝癌完全切除术的184例患者进行了分类，根据8个当代分期系统。这些系统预测随机选择的患者对的相对生存率的能力使用Harrel的一致性指数进行量化。一个新的预后诺模图构建使用asthistically相关variables.RESULTS：后的中位随访46个月的生存患者，中位总生存期为38个月。现有分期系统的一致性指数范围为0.54至0.59。只有2002年美国癌症联合委员会的系统证明了一致性指数的95%置信区间超过0.5，表明传统系统预测随机选择的患者对的相对生存率的能力通常并不比机会好。我们根据患者年龄、血清甲胎蛋白水平、手术失血量、切缘状态、肿瘤大小、卫星病变和血管侵犯建立了一种新的列线图。列线图显示出显著优越的上级一致性指数为0.74（95% CI，0.68 - 0.80）。一个单独的诺模图预测无复发生存率也generated.CONCLUSIONS：当代肝癌分期系统不能准确预测术后结果。我们的预后列线图提供了一种准确预测生存和危险分层的机制，需要在其他肝胆中心进行验证。
BACKGROUND: Prediction of survival after resection of hepatocellular carcinoma (HCC) remains difficult. Numerous staging systems have been devised for purposes of risk classification; we sought to identify the optimal staging system to predict postoperative survival.STUDY DESIGN: One hundred eighty-four patients who underwent primary complete resection of HCC at our institution between 1989 and 2002 were classified according to 8 contemporary staging systems. The ability of these systems to predict relative survival for randomly selected pairs of patients was quantified using the Harrel's concordance index. A novel prognostic nomogram was constructed using prognostically relevant variables.RESULTS: After a median followup of 46 months for surviving patients, the median overall survival was 38 months. The concordance indices for the existing staging systems ranged from 0.54 to 0.59. Only the 2002 American Joint Commission on Cancer system demonstrated a concordance index with a 95% confidence interval exceeding 0.5, indicating that the ability of conventional systems to predict relative survival of randomly selected pairs of patients was generally no better than chance. We developed a novel nomogram based on patient age, serum alpha-fetoprotein level, operative blood loss, resection margin status, tumor size, satellite lesions, and vascular invasion. The nomogram demonstrated a markedly superior concordance index of 0.74 (95% CI, 0.68 to 0.80). A separate nomogram for prediction of recurrence-free survival was also generated.CONCLUSIONS: Contemporary staging systems for HCC do not accurately predict postoperative outcomes. Our prognostic nomogram provides a mechanism for accurate prediction of survival and risk stratification and will require validation at other hepatobiliary centers.