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

Prognostic factors for hepatocellular carcinoma of China liver cancer stagingⅢafter radiotherapy and prediction nomogram construction

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CNLCⅢ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CNLCⅢ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CNLCⅢ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。

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 stageⅢHCC 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.