列线图预测肝癌肺转移患者的总体和癌症特异性生存率:一项回顾性队列研究  

Nomogram Prediction of Overall and Cancer-specific Survival in Patients with Hepatocellular Carcinoma and Pulmonary Metastasis:A Retrospective Cohort Study

作　　者：冯锦城 李民 熊俊[1] Feng Jincheng;Li Min;Xiong Jun(Department of Liver Transplantation,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Hepatobiliary Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院肝脏移植中心,武汉430022 [2]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2024年第1期19-25,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.82172754)。

摘　　要：目的 研究肝癌肺转移患者总生存期和癌症特异性生存期的影响因素,并建立列线图模型。方法 纳入2010年至2016年在美国国立癌症研究所的监测、流行病学、结果数据库(SEER)记录的2242例患者,这些患者在初诊时已确诊为肝癌肺转移。采用多变量Cox比例风险回归模型分析总生存期和癌症特异性生存期的影响因素,并构建预测1年总生存期和癌症特异性生存期的列线图。数据分析与列线图模型的建立采用Cox风险比例回归模型、Kaplan-Meier曲线(Log-rank检验)及一致性指数(C指数)。结果 肝癌肺转移患者1年的总生存率和癌症特异性生存率分别为10.5%(95%CI:8.7%~12.7%)和11.8%(95%CI:9.8%~14.2%)。在多变量生存分析中,保险状态、小肿瘤(大小≤10 cm)、肿瘤分期1~2、甲胎蛋白(AFP)阴性、化疗使用和接受手术是总生存期的独立预后因素;性别、保险状态、肿瘤分期、AFP状态、化疗的使用和接受手术被纳入癌症特异性生存期预测的列线图中。经重抽样方法,列线图预测总生存期和癌症特异性生存期的校正C指数分别为0.72(95%CI:0.70~0.74)和0.71(95%CI:0.69~0.73)。模型的校准曲线显示,通过该列线图得出的生存率预测值和实际预测值之间具有良好的一致性。结论 根据独立预后因素建立的列线图可相对准确地预测肝癌肺转移患者的预后。Objective To study the influencing factors of overall survival(OS)and cancer-specific survival(CSS)in patients with hepatocellular carcinoma and pulmonary metastasis and establish nomograms to predict survival.Methods The study population consisted of 2242cases with a first primary hepatocellular carcinoma who presented with pulmonary metastasis at the time of diagnosis in the Surveillance,Epidemiology,and End Results(SEER)database of the National Cancer Institute from 2010 to 2016.The influencing factors of OS and CSS were evaluated by using multivariable Cox proportional hazards regression models.Nomograms predicting 1-year OS and CSS were constructed.Data analysis and construction of nomograms were performed with Cox proportional hazards regression models,the Kaplan-Meier curves(log-rank test)and C-index.Results The 1-year OS and CSS rates in the cohort were 10.5%(95%CI:8.7%—12.7%)and 11.8%(95%CI:9.8%—14.2%),respectively.In multivariable survival analysis,insurance status,small tumor,tumor stage 1—2,negative AFP,chemotherapy treatment,and surgical treatment were associated with OS.Sex,insurance status,tumor staging,AFP status,chemotherapy and surgery treatment were incorporated into the nomogram for CSS prediction.The bootstrap-corrected concordance indexes(C-indexes)predicted by nomogram were 0.72(95%CI:0.70—0.74)and 0.71(95%CI:0.69—0.73),which could be used to predict OS and CSS.The models were internally validated and shown to have good calibration.Conclusion The nomograms are established based on the associated factors,which shows good performance in predicting survival in patients with hepatocellular carcinoma and pulmonary metastasis.

关 键 词：肝细胞癌 肺转移 列线图 癌症特异性生存率 

分 类 号：R735.7[医药卫生—肿瘤]