香港肝癌分期对TACE联合索拉非尼治疗中国人群的预后预测作用

The prognostic value of Hong Kong liver cancer staging system in Chinese HCC patients receiving transcatheter arterial chemoembolization combined with sorafenib

目的评估和比较香港肝癌分期(HKLC)和巴塞罗那肝癌(BCLC)分期对TACE联合索拉非尼治疗中国肝细胞癌(HCC)人群的预后预测作用和适用性。方法纳入2014年1月至2018年12月430例初发行TACE联合索拉非尼治疗的HCC患者,基于总体生存时间计算并比较HKLC和BCLC分期的生存鉴别能力[Harrell C值和赤池信息量准则(AIC)]、单调性(线性卡方检验)、一致性(似然比卡方检验)、校准能力[验证队列与原始预测的校正图(R^(2))]。结果入组人群的生存时间为13.8(12.4,15.2)个月,基于5亚组分类的HKLC-5、基于9亚组分类的HKLC-9及BCLC分期各自亚组间的生存时间差异有统计学意义(P<0.01)。HKLC-9在生存鉴别能力(HKLC-5:C=0.662,AIC=2906.350;HKLC-9:C=0.682,AIC=2904.269;BCLC:C=0.682,AIC=2911.836)和一致性(HKLC-5、HKLC-9、BCLC的似然比卡方检验值分别为67.389、69.325、63.980)方面表现最佳,BCLC在单调性方面表现最佳(HKLC-5、HKLC-9、BCLC的线性卡方检验值分别为15.975、17.550、26.549),3个分期均显示较高的校准能力。结论相比于BCLC分期,HKLC分期更适合预测接受TACE联合索拉非尼的中国HCC人群的预后。

Objective To validate the prognostic value of Hong Kong liver cancer(HKLC)staging system in Chinese hepatocellular carcinoma(HCC)patients receiving transcatheter arterial chemoembolization(TACE)combined with sorafenib,and to compared it with that of Barcelona clinic liver cancer(BCLC)staging system.Methods This multicenter retrospective study included 430 initial HCC patients,who received TACE combined with sorafenib between January 2014 and December 2018.Based on the overall survival(OS)time,the survival discrimination,including Harrell C value and Akaike information criterion(AIC),the monotonicity of the gradient(linear trend chi-square test),the homogeneity(likelihood ratio chi-square test),and calibration(calibration diagrams of validation queue and original prediction,R^(2)),were calculated and compared between HKLC staging system and BCLC staging system.Results The median OS time of the enrolled patients was 13.8 months(12.4-15.2 months),and statistically significant differences in OS time existed between each other among the 5 subgroups defined by HKLC-5,between each other among the 9 subgroups defined by HKLC-9,and between each other among the subgroups defined by BCLC(P<0.001).HKLC-9 showed best value in the survival discrimination(HKLC-5:C=0.662,AIC=2906.350;HKLC-9:C=0.682,AIC=2904.269;and BCLC:C=0.682,AIC=2911.836)and in the homogeneity(likelihood ratio chi-square test for HKLC-5,HKLC-9 and BCLC being 67.389,69.325and 63.980 respectively),while BCLC presented best value in the monotonicity of the gradient(linear trend chisquare test for HKLC-5,HKLC-9 and BCLC being 15.975,17.550 and 26.549 respectively).All the three systems demonstrated higher calibration capability.Conclusion Compared with BCLC staging system,HKLC staging system is more suitable for the prognostic value in Chinese HCC patients receiving TACE combined with sorafenib.(J Intervent Radiol,2022,31:247-252)