Novel microvascular invasion-based prognostic nomograms to predict survival outcomes in patients after R0 resection for hepatocellular carcinoma
Novel microvascular invasion-based prognostic nomograms to predict survival outcomes in patients after R0 resection for hepatocellular carcinoma
复制标题
基于微血管侵犯的新型预后列线图可预测肝细胞癌 R0 切除后患者的生存结果
DOI：
10.1007/s00432-016-2286-1
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发表时间：
2017-02-01
影响因子：
3.6
通讯作者：
Cong, Wen-Ming
中科院分区：
文献类型：
--
作者：
Feng, Long-Hai;Dong, Hui;Cong, Wen-Ming
目的提出一种新的微血管浸润（MVI）的组织病理学分类系统，并建立诺模图来预测肝细胞癌（HCC）患者R 0肝切除术后的术后生存和早期肿瘤复发。方法回顾性分析2009年12月至2010年4月在我院行R 0肝切除术的686例HCC患者的临床资料。根据MVI的组织学特征建立了分型系统。然后使用多变量考克斯比例风险模型制定列线图进行分析。结果进行了验证，使用bootstrap resception和一个新的225例患者验证队列在2010年5月和6月在同一institution.ResultsA 4-分层分类系统的MVI成立，令人满意地确定了生存和早期肿瘤复发的风险。然后，建立了预测生存的八因素诺模图和预测早期肿瘤复发的七因素诺模图。生存预测列线图的一致性指数为0.78，复发预测列线图的一致性指数为0.72。这些指数均显著高于以下三种常用的分期系统：肿瘤-淋巴结-转移分期系统（第七版，0.67/0.65）、日本综合分期系统（0.58/0.58）和中国大学预后指数（0.52/0.51）。校准曲线显示列线图预测与实际生存结果之间的良好一致性。这些结果证实了在validation cohol.ConclusionsThe新的分类系统MVI和诺模图使更准确的预测R 0肝切除术后的肝癌患者的肿瘤复发和总生存率的风险。
PurposeTo propose a novel histopathological classification system for microvascular invasion (MVI) and to establish nomograms to predict postoperative survival and early tumor recurrence in patients with hepatocellular carcinoma (HCC) after R0 liver resection.MethodsThe clinicopathological and follow-up data of 686 consecutive patients with HCC who underwent R0 liver resection in our hospital between December 2009 and April 2010 were retrospectively reviewed. A classification system was established based on histological characteristics of MVI. Nomograms were then formulated using a multivariate Cox proportional hazards model to analyze. The results were validated using bootstrap resampling and a new 225-patient validation cohort operated in May and June 2010 at the same institution.ResultsA 4-stratification classification system of MVI was established, which satisfactorily determined the risk of survival and early tumor recurrence. Then, an eight-factor nomogram for survival prediction and a seven-factor nomogram for prediction of early tumor recurrence were established. The concordance indices were 0.78 for the survival-prediction nomogram and 0.72 for the recurrence-prediction nomogram. These indices were both significantly higher than the following three commonly used staging systems: tumor–node–metastasis staging system (seventh edition, 0.67/0.65), Japan Integrated Staging System (0.58/0.58) and Chinese University Prognostic Index (0.52/0.51). The calibration curves showed good agreement between predictions by the nomograms and actual survival outcomes. These results were confirmed in the validation cohort.ConclusionsThe novel classification system of MVI and the nomograms enabled more accurate predictions of risk of tumor recurrence and overall survival in patients with HCC after R0 liver resection.