Nomogram-based prognostic stratification for patients with large hepatocellular carcinoma: a population study of SEER database and a Chinese cohort.

IF 2 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of gastrointestinal oncology Pub Date : 2024-10-31 Epub Date: 2024-10-08 DOI:10.21037/jgo-24-288

Kun Ji, Hanlong Zhu, Cong Zhang, Jing Ai, Li Jing, Tiejian Zhao, Hui Tao, Feng Chen, Wei Wu

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引用次数: 0

Abstract

Background: Large hepatocellular carcinoma (HCC) with a diameter ≥5 cm remains a significant challenge of poor survival and raises the need for prognosis evaluation. This study aimed to develop and validate a nomogram-based prognostic stratification to assess overall survival (OS) of patients with large HCC.

Methods: Data of patients with large HCC were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database and our hospital, and were divided into the training cohort, internal validation cohort and external validation cohort. Cox analysis was performed to identify independent prognostic factors for the construction of nomogram in training cohort. The predictive ability of the nomogram was validated compared with the tumor node metastasis (TNM) classification staging system. Furthermore, prognostic stratification system based on nomogram was developed.

Results: Independent prognostic factors including histological grade, T stage, M stage, alpha fetoprotein (AFP), fibrosis score and surgery, were incorporated to construct nomogram. C-indexes of nomogram were 0.730, 0.726 and 0.724 in the training, internal and external validation cohorts, respectively. Importantly, nomogram harbored a superior discrimination and clinical benefit than the TNM staging system. Nomogram-based prognostic stratification divided patients into three groups: 345-414 (low-risk group), 415-460 (medium-risk group) and 461-513 (high-risk group). As shown in Kaplan-Meier curves, there were significant differences in OS among low-, medium- and high-risk groups (P<0.01).

Conclusions: Nomogram showed a superior prognostic predictive ability compared with the TNM staging system. The prognostic stratification serves as a valuable tool to assist clinicians on the selection of optimal treatment method and follow-up plan, particularly for the high-risk population.

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基于提名图的大肝细胞癌患者预后分层：SEER 数据库和中国队列的人口研究。

背景：直径≥5厘米的大肝细胞癌（HCC）仍然是生存率低的一个重大挑战，并提出了对预后评估的需求。本研究旨在开发和验证一种基于提名图的预后分层方法，以评估大肝细胞癌患者的总生存率（OS）：方法：从监测、流行病学和最终结果（SEER）数据库和本医院回顾性收集大型 HCC 患者的数据，并将其分为训练队列、内部验证队列和外部验证队列。在训练队列中进行了Cox分析，以确定构建提名图的独立预后因素。通过与肿瘤结节转移（TNM）分类分期系统进行比较，验证了提名图的预测能力。此外，还建立了基于提名图的预后分层系统：包括组织学分级、T分期、M分期、甲胎蛋白（AFP）、纤维化评分和手术在内的独立预后因素被纳入提名图。在训练组、内部和外部验证组中，提名图的 C 指数分别为 0.730、0.726 和 0.724。重要的是，与 TNM 分期系统相比，提名图具有更高的区分度和临床效益。基于提名图的预后分层将患者分为三组：345-414（低危组）、415-460（中危组）和461-513（高危组）。如 Kaplan-Meier 曲线所示，低危、中危和高危组的 OS 存在显著差异（PConclusions：与 TNM 分期系统相比，Nomogram 的预后预测能力更强。预后分层是协助临床医生选择最佳治疗方法和随访计划的重要工具，尤其是对于高危人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of gastrointestinal oncology Medicine-Oncology

CiteScore

3.20

自引率

0.00%

发文量

171

期刊介绍： ournal of Gastrointestinal Oncology (Print ISSN 2078-6891; Online ISSN 2219-679X; J Gastrointest Oncol; JGO), the official journal of Society for Gastrointestinal Oncology (SGO), is an open-access, international peer-reviewed journal. It is published quarterly (Sep. 2010- Dec. 2013), bimonthly (Feb. 2014 -) and openly distributed worldwide. JGO publishes manuscripts that focus on updated and practical information about diagnosis, prevention and clinical investigations of gastrointestinal cancer treatment. Specific areas of interest include, but not limited to, multimodality therapy, markers, imaging and tumor biology.