Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy
Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy
复制标题
基于炎症相关标志物的肝细胞癌肝切除患者的新型预后列线图
DOI：
10.4143/crt.2018.657
复制
发表时间：
2019-10-01
影响因子：
4.6
通讯作者：
Peng, Sui
中科院分区：
文献类型：
--
作者：
Wang, Yifei;Sun, Kaiyu;Peng, Sui
目的肝细胞癌（Hepatocellular carcinoma，HCC）是一种侵袭性疾病，复发率高.然而，目前的分期系统缺乏预测肝癌复发的能力。我们的目的是建立基于炎症相关标志物的肝癌患者行肝切除术的预后列线图。材料与方法我们从两个医疗中心招募了889名手术治疗的患者。通过考克斯回归分析确定了独立的预后因素。建立了无复发生存期（RFS）和总生存期（OS）的列线图，并在内部和外部进行了验证。评估列线图的性能、辨别力和校准，并与现有分期系统进行比较。结果中性粒细胞/淋巴细胞比值（NLR）和γ-谷氨酰转肽酶/血小板比值（GPR）是与生存率独立相关的两个炎症相关因子。NLR、GPR、国际标准化比值（INR）、微血管浸润、卫星病变、肿瘤数量、肿瘤直径和大血管浸润用于构建RFS的诺模图，而GPR、总胆红素、INR、甲胎蛋白、微血管浸润、卫星病变、肿瘤直径和大血管浸润用于构建OS的诺模图。列线图C指数为0.701（95%置信区间[CI]，0.669 - 0.732），RFS和0.761（95% CI，0.728至0.795）。这些结果得到内部和外部验证，C指数为0.701 RFS分别为0.707（95% CI，0.647 - 0.755）和0.707（95% CI，0.657 - 0.756），OS分别为0.706（95% CI，0.640 - 0.772）和0.708（95% CI，0.646 - 0.771）。列线图显示出优于传统分期系统的准确性（p<0.001）。结论基于炎症相关标志物的诺模图预测肝癌切除术后患者生存率具有较高的有效性，对指导术后干预和随访具有重要价值。
Purpose Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy. Materials and Methods We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed, and compared with existed staging systems. Results Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001). Conclusion The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.