Development and Validation of a Novel Model to Predict Regional Lymph Node Metastasis in Patients With Hepatocellular Carcinoma.
Development and Validation of a Novel Model to Predict Regional Lymph Node Metastasis in Patients With Hepatocellular Carcinoma.
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预测肝细胞癌患者区域淋巴结转移的新模型的开发和验证
DOI：
10.3389/fonc.2022.835957
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发表时间：
2022
影响因子：
4.7
通讯作者：
Wang X
中科院分区：
文献类型：
--
作者：
Chen X;Lu Y;Shi X;Han G;Zhao J;Gao Y;Wang X
肝细胞癌（HCC）淋巴结状态的评估是一个经典但有争议的话题。本研究旨在探讨淋巴结转移（LNM）的发生率，探讨淋巴结清扫（LND）的作用，并建立和验证一种新的模型来预测肝癌非其他特异性（NOS）患者的淋巴结转移。研究队列取自监测、流行病学和最终结果数据库。采用Joinpoint回归计算年变化百分数（APC）。生存分析采用竞争风险模型。基于最小绝对收缩和选择算子（LASSO）逻辑回归算法构建nomogram，并通过标定曲线进行验证。获得受试者工作特征曲线下面积（AUROC）以比较预后表现。采用决策曲线和临床影响曲线分析来检验模型的临床应用价值。最终共有8829例患者入组，其中1346例（15.2%）患者接受了LND治疗。近10年LND率无明显波动，APC为0.5% （P=0.593）。56例（4.2%）患者中发现LNM，并确认为HCC患者的独立预后因素（P=0.005）。共检出淋巴结2497个，阳性93个（3.7%）。在倾向评分匹配后，LND显示没有直接的肿瘤学益处，也没有加剧竞争风险。此外，淋巴结数量的增加并不能改善预后。将1346例LND患者按1:1的比例随机分为训练组和验证组。种族、肿瘤大小、临床T分期、肝外胆管侵犯和肿瘤分级是LNM的独立危险因素。所构建的模型经良好的校正，在临床实践中具有良好的鉴别能力和净效益。LNM是HCC的独立预后因素，但对于HCC患者，常规LND似乎是不必要的。所构建的模型能够较好地预测HCC患者是否存在LNM，对患者分层和个体化治疗策略优化具有重要意义。
The evaluation of the nodal status of hepatocellular carcinoma (HCC) is a classic but controversial topic. This study aimed to investigate the incidence of lymph node metastasis (LNM), explore the role of lymph node dissection (LND), and develop and validate a novel model to predict LNM in patients with HCC, not other specified (NOS). The study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) was calculated using the Joinpoint regression. Survival analyses adopted the competing risk model. The nomogram was constructed based on the least absolute shrinkage and selection operator (LASSO) logistic regression algorithm and validated by calibration curves. The area under the receiver operating characteristic curve (AUROC) was obtained to compare prognostic performance. Decision curve and clinical impact curve analyses were introduced to examine the clinical value of the models. A total of 8,829 patients were finally enrolled in this study, and 1,346 (15.2%) patients received LND. The LND rate showed no noticeable fluctuation in the last decade, with an APC of 0.5% (P=0.593). LNM was identified in 56 (4.2%) patients and confirmed an independent prognostic factor of HCC patients (P=0.005). There were 2,497 lymph nodes retrieved, and 93 (3.7%) of them were positive. After propensity score matching, LND indicated no direct oncologic benefit and did not worsen competing risks. Moreover, an increased number of lymph nodes retrieved could not improve prognoses. 1,346 patients with LND were further randomly divided into the training and validation sets with the ratio of 1:1. Race, tumor size, clinical T stage, extrahepatic bile duct invasion, and tumor grade were independent risk factors for LNM. The constructed model was well calibrated and showed good discrimination power and net benefits in clinical practice. LNM is an independent prognostic factor in HCC, but routine LND seems to be unnecessary in HCC patients. The constructed model could predict the presence of LNM in HCC patients with good performance, which is meaningful to patient stratification and individual treatment strategies optimization.
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