Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma.
Morbidity, Prognostic Factors, and Competing Risk Nomogram for Combined Hepatocellular-Cholangiocarcinoma.
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合并性肝细胞胆管癌的发病率、预后因素和竞争风险列线图
DOI：
10.1155/2021/3002480
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发表时间：
2021
影响因子：
--
通讯作者：
Wang X
中科院分区：
文献类型：
--
作者：
Chen X;Lu Y;Shi X;Chen X;Rong D;Han G;Zhang L;Ni C;Zhao J;Gao Y;Wang X
合并肝细胞-胆管癌（CHC）是原发性肝癌中一种罕见且异质性的组织学亚型，目前对其了解甚少。本研究旨在描述CHC的流行病学和临床特征，探讨预后指标，并制定CHC的竞争风险图。研究队列取自监测、流行病学和最终结果数据库。采用结合点回归计算发病率的年变化百分率（APC）。nomogram是基于多变量竞争风险生存分析建立的，并通过校准曲线进行验证。获得Akaike信息准则、Bayesian信息准则、Harrell’s c指数和受试者工作特征曲线下面积来比较预后表现。采用决策曲线分析检验模型的临床应用价值。2004年CHC总发病率为0.062 / 10万人，2018年为0.081 / 10万人，APC为1.0% （P < 0.05）。CHC表现为肝细胞癌和肝内胆管癌的中间临床病理特征。种族、肿瘤大小、血管侵犯、肝外侵犯、远处转移、分级、手术和Metavir分期被证实为癌症特异性生存的独立预测因素。所构建的nomogram经过了很好的校准，与目前的美国癌症分期联合委员会相比，具有更好的鉴别能力和更高的净效益。肝移植患者的生存率高于肝切除术患者，尤其是符合米兰标准的患者（P=0.022和P=0.015）。在超出米兰标准的患者中，肝移植和肝切除术的生存率无差异（P=0.340）。2004 - 2018年CHC发病率保持稳定。所构建的nomogram能较好地预测预后，对个体化治疗策略的优化具有重要意义。CHC患者也应被视为潜在的肝移植受体，特别是那些符合米兰标准的患者，但这一发现仍需要更多的证据来进一步证实。
Combined hepatocellular-cholangiocarcinoma (CHC) is a rare and heterogeneous histological subtype of primary liver cancer, which is still poorly understood. This study aimed to describe the epidemiological and clinical features, investigate the prognostic indicators, and develop a competing risk nomogram for CHC. The study cohort was taken from the Surveillance, Epidemiology, and End Results database. The annual percent change (APC) in incidence was calculated using the joinpoint regression. The nomogram was developed based on multivariate competing risk survival analyses and validated by calibration curves. Akaike information criterion, Bayesian information criterion, Harrell's C-index, and area under the receiver operating characteristic curves were obtained to compare prognostic performance. Decision curve analysis was introduced to examine the clinical value of the models. The overall incidence of CHC was 0.062 per 100,000 individuals in 2004 and 0.081 per 100,000 individuals in 2018, with an APC of 1.0% (P > 0.05). CHC displayed intermediate clinicopathological features of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Race, tumor size, vascular invasion, extrahepatic invasion, distant metastasis, grade, surgery, and Metavir stage were confirmed as the independent predictors of cancer-specific survival. The constructed nomogram was well calibrated, which showed better discrimination power and higher net benefits than the current American Joint Committee on Cancer staging system. Patients with liver transplantation had better survival than those with hepatectomy, especially patients within the Milan Criteria (P=0.022 and P=0.015). There was no survival difference between liver transplantation and hepatectomy in patients beyond the Milan Criteria (P=0.340). The morbidity of CHC remained stable between 2004 and 2018. The constructed nomogram could predict the prognosis with good performance, which was meaningful to individual treatment strategies optimization. CHC patients should also be considered as potential liver transplantation recipients, especially those within the Milan Criteria, but the finding still needs more evidence to be further confirmed.
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影响因子：
3.2
作者：
Ishii T;Ito T;Sumiyoshi S;Ogiso S;Fukumitsu K;Seo S;Taura K;Uemoto S
通讯作者：
Uemoto S
影响因子：
3.2
作者：
Amini, Neda;Ejaz, Aslam;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
2.1
作者：
Jaradat, Derar;Bagias, Georgios;Oezcelik, Arzu
通讯作者：
Oezcelik, Arzu
影响因子：
5.2
作者：
Kang CM;Suh KS;Yi NJ;Hong TH;Park SJ;Ahn KS;Hayashi H;Choi SB;Jeong CY;Takahara T;Shiozaki S;Roh YH;Yu HC;Fukumoto T;Matsuyama R;Naoki U;Hashida K;Seo HI;Okabayashi T;Kitajima T;Satoi S;Nagano H;Kim H;Taira K;Kubo S;Choi DW
通讯作者：
Choi DW
影响因子：
2
作者：
Austin PC;Fine JP
通讯作者：
Fine JP