AFP阴性肝细胞癌特异生存时间的预测模型研究  

Establishment of A Prediction Model for the Survival Rate of Patients with AFP-negative Hepatocellular Carcinoma

作　　者：施文武[1,2] 杨艳红 陈智敏 廖小莉[4] 刘瑞 SHI Wenwu;YANG Yanhong;CHEN Zhimin(Chongzhou People's Hospital,Chengdu,611230)

机构地区：[1]四川省崇州市人民医院,611230 [2]四川省医学科学院崇州分院,611230 [3]重庆市忠县中医院,404399 [4]广西医科大学附属肿瘤医院,530021 [5]重庆医科大学附属第二医院,400042

出　　处：《实用癌症杂志》2023年第3期431-436,共6页The Practical Journal of Cancer

基　　金：广西医药卫生适宜技术开发与推广应用项目(编号:S2020100)。

摘　　要：目的 探讨AFP阴性肝细胞癌(hepatocellular carcinoma, HCC)患者特异生存时间的影响因素,并构建预后预测模型以评估患者的特异生存时间。方法 收集SEER数据库中2006~2016年诊断的首发HCC患者的临床资料;使用Sample函数将所有患者按照1∶1随机分为训练组和验证组;运用Cox比例风险回归模型探索预后影响因素;利用列线图构建预测模型并采用ROC曲线下面积和校准曲线验证模型的预测效果和临床应用价值。结果 诊断年龄>64岁、N1期和肿瘤大小>5 cm是AFP阴性HCC患者特异生存预后的独立危险因素(P<0.05);而手术治疗和部分淋巴结移除是独立保护因素(P<0.05)。在训练组中1、3和5年ROC曲线下面积分别为0.756、0.761和0.781;验证组中分别为0.799、0.722和0.735。校准曲线显示,在训练组和验证组中预测1、3、5年的生存率均接近实际生存率。基于列线图进行风险分层,KM法分析结果显示,低分险组特异生存时间均明显优于高风险组(P<0.001)。结论 采用列线图构建的预后模型能有效地预测AFP阴性HCC患者的特异生存时间,可在一定程度上协助临床医生直观便捷地进行临床决策。Objective To explore the affecting factors of the cancer specific survival time of patients with AFP-negative hepatocellular carcinoma(HCC),and establishment a prognostic prediction model to evaluate the cancer specific survival time of patients.Methods Collect the clinical data of first-onset HCC patients diagnosed from 2006 to 2016 in the SEER database;used the Sample function to randomly divide all patients into the training group and the validation group according to 1∶1;used the Cox proportional hazard regression model to explore the prognostic factors;used nomogram constructs the prediction model and used the receiver operating characteristic curve(ROC curve) and the calibration curve to verify the prediction effect and clinical application value of the model.Results Diagnosis age>64 years old, N1 stage and tumor size>5cm were independent risk factors for cancer specific survival time in patients with AFP-negative HCC(P<0.05);while surgical treatment and lymph node removal were independent protective factors(P<0.05).The area under the ROC curve for 1,3,and 5-year survival rates in the training group were 0.756,0.761,and 0.781,respectively;in the validation group, they were 0.799,0.722,and 0.735,respectively.The calibration curve shows that the predicted 1,3,and 5-year survival rates in the training group and the validation group are close to the actual survival rates.Based on the nomogram for risk stratification, the results of KM analysis showed that the cancer specific survival of the low-risk group was significantly better than that of the high-risk group(P<0.001).Conclusion The prognostic model constructed by the nomogram in this study can effectively predict the cancer specific survival time of AFP-negative HCC patients, and to a certain extent can assist clinicians in intuitive and convenient clinical decision-making.

关 键 词：AFP阴性 肝细胞癌 癌症特异性生存 列线图 

分 类 号：R735.7[医药卫生—肿瘤]