乙型肝炎相关肝内胆管癌病人术后生存列线图  

A nomogram to predict postoperative survival in patients with hepatitis B virus-related intrahepatic cholangiocarcinoma

作　　者：陈秦俊杰 项红军[1] 夏勇[1] 李俊[1] 沈锋[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200438

出　　处：《外科理论与实践》2017年第2期151-156,共6页Journal of Surgery Concepts & Practice

基　　金：国家科技重大专项(2012ZX10002016);上海市科委医学引导基金(16411966200)

摘　　要：目的:建立一个有效的列线图预测乙型肝炎(乙肝)相关肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)病人的术后生存。方法:回顾性分析我院2003年1月至2009年12月期间415例乙肝相关ICC手术病人临床数据(模型组),通过COX回归模型的结果建立预测病人术后生存的列线图。用2010年在我院行手术治疗的126例乙肝相关ICC病人的临床资料(验证组)来验证列线图的预测效果。生存曲线比较TNM分期与列线图对病人的预测。通过一致性指数(C-index)比较TNM分期与列线图对病人生存预测的准确性。结果:列线图共包含6个预测指标。模型组的列线图预测术后生存的C-index值0.72(95%CI:0.70~0.73),验证组C-index值0.73(95%CI:0.71~0.76),证实列线图对生存的预测准确度高。列线图预测包括模型组和验证组541例病人术后生存的C-index值是0.71(95%CI:0.68~0.74),高于美国癌症联合会第7版TNM分期的0.63(95%CI:0.60~0.66)。结论:基于HBV-DNA载量、CA19-9、肝硬化、术中输血、肿瘤直径以及淋巴结转移构建预测的列线图可提高乙肝相关ICC病人术后生存的预测准确度。Objective To establish an effective nomogram that predict postoperative survival in the patients with he- patitis B virus-related intrahepatic cholangiocarcinoma （ICC）. Methods The clinical data of 415 patients （model group） with hepatitis B virus-related ICC receiving surgical treatment between January 2003 and December 2009 were analyzed retrospectively. A nomogram was established based on the results of COX regression model. The clinical data of 126 patients with hepatitis B virus-related ICC receiving liver resection in our hospital in 2010 served as validation group to verify the prognostic results of nomogram. The survival curve was used to evaluate the TNM staging and the nomogram to predict the prognosis of patients. Concordance index （C-index） was used to compare the predictive accuracy between the nomogram and TNM staging. Results The nomogram consisted of 6 factors. In model group, the C-index of predicting over- all survival （OS） was 0.72 （95%CI： 0.70-0.73）. It was shown that the nomogram had high accuracy of prediction by C-index of 0.73 （95%CI： 0.71-0.76） in validation group. The C-index of nomogram for predicting survival of 541 cases including model group and validation group was 0.71 （95%CI： 0.68-0.74）, which was higher than the C-index （0.63, 95%CI： 0.60- 0.66） of American Joint Committee on cancer 7th edition. Conclusions A nomogram based on HBV-DNA level, CA19-9, cirrhosis, intraoperative blood transfusion, tumor diameter and lymph node metastasis could improve the prediction of OS in patients with hepatitis B virus-related ICC after surgery.

关 键 词：肝内胆管癌 乙型肝炎病毒 列线图 预后 

分 类 号：R735.8[医药卫生—肿瘤]