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中国癌症防治杂志

中国癌症防治杂志 ›› 2023, Vol. 15 ›› Issue (2): 195-201.doi: 10.3969/j.issn.1674-5671.2023.02.13

• 临床研究 • 上一篇    下一篇

中国肝癌分期Ⅲ期肝细胞癌放疗后预后因素分析及列线图构建

  

  1. 广西医科大学附属肿瘤医院1实验研究部，放疗科，化疗科；广西医科大学公共卫生学院流行病与卫生统计学；广西医科大学附属肿瘤医院科研科；区域性高发肿瘤早期防治研究教育部重点实验室（广西医科大学）；广西壮族自治区卫生健康委员会肿瘤分子医学重点（培育）实验室
  • 出版日期:2023-04-25 发布日期:2023-05-05
  • 通讯作者: 余红平 E-mail：yuhongping@stu.gxmu.edu.cn
  • 基金资助:
    国家自然科学基金项目（81660567）；广西重点研发计划项目（桂科AA18221001）；广西自然科学基金重点项目（2018GXNSFDA?050012）；广西壮族自治区卫生健康委员会肿瘤分子医学重点（培育）实验室（ZPTJ2020001）；区域高发肿瘤防治教育部/广西重点实验室自主研究项目（GKE?ZZ202104；GKE?ZZ202118）；广西医疗卫生适宜技术开发与推广应用项目（S2021022）；上海吴孟超医学科技基金会项目（JJHXM?2019042）

Prognostic factors for hepatocellular carcinoma of China liver cancer staging Ⅲ after radiotherapy and prediction nomogram construction

  • Online:2023-04-25 Published:2023-05-05

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摘要： 目的 探讨影响接受调强放疗（intensity⁃modulated radiotherapy，IMRT）的中国肝癌分期（China liver cancer staging，CNLC）Ⅲ期肝细胞癌（hepatocellular carcinoma，HCC）患者预后的危险因素，并建立预后列线图模型。方法 收集2012年1月到2021年3月在广西医科大学附属肿瘤医院接受IMRT治疗的CNLC Ⅲ期HCC患者的临床资料进行回顾性分析。采用单因素和多因素Cox回归分析影响患者预后的独立危险因素。构建列线图模型预测患者1年、 2年、3年的总生存率，并采用受试者工作特征（receiver operating characteristic，ROC）曲线和校准曲线评估模型效能。根据 Cox 模型风险评分的中位数将患者分为高、低风险组，使用Kaplan⁃Meier 法绘制生存曲线图，log⁃rank检验分析两组的生存差异。结果 本研究共纳入250 HCC例患者。多因素Cox回归分析结果显示，肿瘤数目、甲胎蛋白（alpha⁃fetoprotein，AFP）、血清碱性磷酸酶(alkaline phosphatase，ALP）、血小板（blood platelet，PLT）是CNLC Ⅲ期HCC患者IMRT预后的独立影响因素（均P<0.05）。列线图模型预测患者1年、2年、3年总生存率的ROC曲线下面积（area under the curve，AUC）分别为0.680（95%CI：0.613~0.748）、0.717（95%CI：0.638~0.796）、0.783（95%CI：0.696~0.871），校准曲线显示预测发生率和实际发生率之间一致性较好。log⁃rank检验显示，低风险组的总生存期（overall survival，OS）明显优于高风险组（P<0.001）。结论 肿瘤数目、AFP、ALP、PLT是影响接受IMRT治疗的CNLC Ⅲ期HCC患者预后的独立危险因素，基于上述指标建立的列线图模型有助于临床医师对患者预后做出更准确的评估并指导临床个体化治疗。

关键词: 肝细胞癌, 中国肝癌分期, 调强放疗, 预后, 列线图

Abstract: Objective To investigate the risk factors affecting the prognosis of patients with China liver cancer staging (CNLC)Ⅲhepatocellular carcinoma (HCC) who received intensity⁃modulated radiotherapy (IMRT), and a prediction nomogram model was established. Methods The clinicopathologic data of CNLC stageⅢ HCC patients who received IMRT treatment in the Guangxi Medical University Cancer Hospital from January 2012 to March 2021 were collected and analyzed retrospectively. Univariable and multivariatble Cox regression models were used to analyze the independent factors affecting the prognosis of patients. A nomogram was constructed to predict 1⁃year, 2⁃year, and 3⁃year overall survival (OS) rates, and the areas under the curve (AUC) of the receiver operating characteristic (ROC) and calibration curves were used to evaluate the efficacy of the model. The patients were divided into high risk group and low risk group, according to the median risk score of Cox model. The survival curves were plotted by using the Kaplan⁃Meier method, and the survival difference between the two groups was analyzed by log⁃rank. Results A total of 250 HCC patients were included in this study. The results of multivariable Cox regression analysis suggested that tumor number, alpha⁃fetoprotein (AFP), alkaline phosphatase (ALP), and blood platelet (PLT) were the independent prognostic factors of IMRT in HCC patients with CNLC stageⅢ (all P<0.05). The AUC of ROC for the prognosis nomogram predicting the OS of patients at 1⁃year, 2⁃year and 3⁃year were 0.680 (95%CI: 0.613-0.748), 0.717 (95%CI: 0.638-0.796) and 0.783 (95%CI:0.696-0.871), respectively. The calibration curves showed good consistency between the predicted rate and the actual rate. Log⁃rank showed that the OS of the low risk group was significantly better than that of the high risk group (P<0.001). Conclusions Tumor number, AFP, ALP and PLT are independent risk factors affecting the prognosis of CNLC stageⅢHCC patients treated with IMRT. The nomogram model established based on the above indexes may help clinicians to make a more accurate prognosis assessment for patients and guide the clinical individualized treatment.

Key words: Hepatocellular carcinoma, China liver cancer staging, Intensity?modulated radiotherapy, Prognosis, Nomogram

中图分类号: 

  • R735.7