老年肝细胞癌患者总生存期的影响因素及预后列线图预测模型构建:一项基于人群的研究

Influencing Factors of Overall Survival of Elderly Patients with Hepatocellular Carcinoma and Construction of Prediction Model of Prognosis Nomogram:A Population-Based Study

目的探讨影响老年(≥60岁)肝细胞癌(HCC)患者总生存期(OS)的独立危险因素并构建列线图预测模型。方法从SEER数据库下载2005—2020年所有老年HCC患者的临床数据。根据纳排标准,将筛选后的患者随机分为训练组(70%)和验证组(30%),单因素和多因素Cox回归分析确定老年HCC患者独立危险因素并用Kaplan-Meier生存分析进一步验证。基于确定的变量,开发并验证列线图,以预测老年HCC患者6、12和24个月的OS。使用一致性指数(C指数)、校准曲线、受试者工作特征(ROC)曲线和曲线下面积(AUC)来评价预测模型的预测效率和区分能力,采用决策曲线分析(DCA)评估列线图的临床潜在应用价值。结果本研究最终纳入1134例老年HCC患者,训练组793例,验证组341例。年龄、临床分级、临床分期、M分期、肿瘤大小分型和放射治疗被确定为该人群的独立预后因素。构建出的列线图表现出优异的预测性能,训练组的C指数为0.745,验证组的C指数为0.704。训练组在6、12和24个月时的AUC值分别为0.785、0.788和0.798,验证组分别为0.780、0.725和0.607。从预测的生存概率到实际观测,校准曲线表现出良好的一致性。ROC曲线和DCA显示本研究提出的列线图具有较好的预测能力。结论年龄、临床分级、临床分期、M分期、肿瘤大小分型和放疗情况均是老年HCC患者生存的重要影响因素。本研究构建的预后列线图预测模型具有良好的预测价值,可用于预测老年HCC患者OS,这将有助于老年HCC患者的个性化生存评估和临床管理。

Objective To explore the independent risk factors that affect the overall survival(OS)of elderly patients with hepatocellular carcinoma(HCC,≥60 years old)and build a nomogram prediction model.Methods Clinical data of all elderly patients with HCC from the SEER database from 2005 to 2020 were downloaded from SEER database.In accordance with the inclusion and exclusion criteria,the screened patients were randomly assigned to a training group(70%)and a validation group(30%).The independent risk factors of elderly patients with HCC were determined by univariate and multivariate Cox regression analyses and further validated by Kaplan-Meier survival analysis.On the basis of the determined variables,nomograms were developed and verified to predict the OS of elderly patients with HCC at 6,12,and 24 months.The consistency index(C index),calibration curve,receiver’s operating characteristic(ROC)curve,and area under curve(AUC)were used to evaluate the prediction efficiency and discrimination ability of the prediction model,and decision curve analysis(DCA)was used to evaluate the potential clinical application value of the nomogram.Results A total of 1134 elderly patients with HCC were included,with 793 in the training group and 341 in the validation group.Seven variables,including age,clinical grade,clinical stage,M stage,tumor size classification,and radiotherapy,were identified as independent prognostic factors of this population.The constructed nomogram shows excellent prediction performance,with C indices of 0.745 in the training group and 0.704 in the validation group.The AUC values of the training group at 6,12,and 24 months were 0.785,0.788,and 0.798,respectively,and those of the validation group were 0.780,0.725,and 0.607,respectively.The calibration curve shows good consistency from the predicted survival probability to the actual probability.The ROC curve and DCA show that the nomogram proposed in this study has good prediction ability.Conclusion Age,clinical grade,clinical stage,M stage,tumor size classification,and radiotherapy are important influencing factors for the survival of elderly patients with HCC.The prediction model of prognosis nomogram constructed in this study has good predictive value,and it can be used to predict the OS of elderly patients with HCC,which could be helpful for individualized survival assessment and clinical management of these patients.