«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《现代预防医学》[ISSN:1003-8507/CN:51-1365/R]

期数:

2022年14期

页码:

2510-2516

栏目:

流行病与统计方法

出版日期:

2022-07-30

文章信息/Info

Title:

Establishment and validation of Nomogram model for intrahepatic bile duct malignancies based on SEER database

作者:

王磊超¹; 2; 王志鑫¹; 2; 冯义康¹; 2; 魏飞¹; 2; 李家俊¹; 2; 樊海宁¹; 2; 侯立朝¹; 2

1.青海大学附属医院肝胆胰外科，青海 西宁 810000；
2.青海省包虫病研究重点实验室，青海 西宁 810000

Author(s):

WANG Lei-chao*;  WANG Zhi-xin;  FENG Yi-kang;  WEI Fei;  LI Jia-jun;  FAN Hai-ning;  HOU Li-zhao

*Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University, Qinghai, Xining 810000, China

关键词:

肝内胆管癌; 预测模型; 列线图; 生存预测

Keywords:

Intrahepatic cholangiocarcinoma;  Prediction model;  Nomogram;  Survival prediction

分类号:

R735.8

DOI:

10.20043/j.cnki.MPM.202110595

文献标识码:

A

摘要:

目的 探讨肝内胆管癌（ICC）行手术治疗后影响患者生存的危险因素，并依据此构建列线图预测模型。 方法 通过SEER*Stat软件从美国国立癌症研究所“监测、流行病学和结果数据库”(the Surveillance，Epidemiology，and End Results，SEER)数据库获取2004—2015年诊断为ICC患者的临床病理资料信息共2 100例，通过R软件中“rms”包将筛选过后的临床病理资料随机分成建模组和验证组，两组人数分别为1 470例和630例，通过使用R软件进行单因素Cox回归分析，根据处理后的结果筛出可能与ICC患者生存相关的危险因素，再将得到的危险因素进行多因素Cox回归分析，基于多因素Cox回归分析的结果构建ICC患者的列线图，模型的预测能力通过受试者工作特征曲线（ROC曲线）、C - index、和校准曲线等方式进行验证。 结果 建模组ICC患者的6、12和24月生存为分别为65.2%、47.5%和29.4%；验证组ICC的6、12和24月生存为分别为70.3%、51.3%和32.2%。多因素Cox分析显示年龄、性别、AJCC State Group分期、手术、肿瘤大小、化疗为影响ICC患者预后的危险因素，根据筛选出的6个独立危险因素所构建的预测模型，C - index为0.742（95%CI：0.729～0.757），建模组中患者6、12和24月的ROC曲线下面积分别为0.848、0.818和0.751。验证组据筛选出的6个独立危险因素所构建的预测模型，C - index为0.737（95%CI：0.715～0.760），验证组中患者6、12和24月的ROC曲线下面积分别为0.772、0.733和0.706。在两组队列中6、12和24月的校准曲线显示两个列线图的预测值和实际观察值高度一致。 结论 通过筛选出的独立危险因素能够很好的预测ICC患者的预后，为临床工作个体化治疗提供参考依据。

Abstract:

Objective To investigate the risk factors affecting patient survival after surgical treatment for intrahepatic cholangiocarcinoma (ICC), and to construct a nomogram prediction model based on this. Methods The Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute (NCI) was used to obtain the data of 2 100 patients diagnosed with ICC from 2004 to 2015 by SEER*Stat software. Patients were randomly divided into a modeling group (1 470 cases) and a validation group (630 cases), by the “rms” package in R software. Single-factor Cox regression analysis was performed by using R software, and risk factors that might be associated with survival of ICC patients were screened out based on the processed results. Then the obtained risk factors were subjected to multi-factor Cox regression analysis, and nomogram of ICC patients were constructed based on the results of multi-factor Cox regression analysis. The predictive ability of the model was verified by means of receiver operating characteristic curves (ROC curves), C-index, and calibration curves. Results The 6-month, 12-month, and 24-month survival of patients with ICC in the modeling group were 65.2%, 47.5%, and 29.4%, respectively. The 6-month, 12-month, and 24-month survival of patients with ICC in the verification group were 70.3%, 51.3%, and 32.2%, respectively. Multivariate COX analysis showed that age, gender, AJCC State Group staging, surgery, tumor size, and chemotherapy were risk factors affecting the prognosis of ICC patients. Based on the six independent risk factors screened out, a predictive model reported a C-index of 0.742 (95%CI: 0.729-0.757), the area under the ROC curve of patients in the modeling group at 6-month, 12-month, and 24-month of 0.848, 0.818, and 0.751, respectively. A prediction model was constructed based on the 6 independent risk factors in the verification group. The C-index was 0.737 (95%CI: 0.715-0.760), and the area under the ROC curve of patients in the verification group at 6-month, 12-month, and 24-month were 0.772, 0.733 and 0.706, respectively. The calibration curves group at 6-month, 12-month, and 24-month in the two cohorts showed that the predicted values of the two nomograms were highly consistent with the actual observations. Conclusion The screening of independent risk factors can well predict the prognosis of ICC patients and provide a reference basis for individualized treatment in clinic.

参考文献/References

[ 1 ]Razumilava N, Gj G. Cholangiocarcinoma[J]. Lancet (London, England), 2014, 383(9935): 2168 - 2179.
[ 2 ]Kelley RK, Bridgewater J, Gj G, et al. Systemic therapies for intrahepatic cholangiocarcinoma[J]. Journal of Hepatology, 2020, 72(2): 353 - 363.
[ 3 ]Massarweh NN, El - Serag HB. Epidemiology of hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Cancer Control: Journal of the Moffitt Cancer Center, 2017, 24(3): 1073274817729245.
[ 4 ]Saha SK, Zhu AX, Fuchs CS, et al. Forty - Year trends in cholangiocarcinoma incidence in the U.S.: intrahepatic disease on the rise[J]. The Oncologist, 2016, 21(5): 594 - 599.
[ 5 ]Bertuccio P, Malvezzi M, Carioli G, et al. Global trends in mortality from intrahepatic and extrahepatic cholangiocarcinoma[J]. Journal of Hepatology, 2019, 71(1): 104 - 114.
[ 6 ]Mazzaferro V, Gorgen A, Roayaie S, et al. Liver resection and transplantation for intrahepatic cholangiocarcinoma[J]. Journal of Hepatology, 2020, 72(2): 364 - 377.
[ 7 ]Zhang H, Yang T, Wu M, et al. Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management[J]. Cancer Letters, 2016, 379(2): 198 - 205.
[ 8 ]Hoshino N, Hida K, Sakai Y, et al. Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer[J]. International Journal of Colorectal Disease, 2018, 33(4): 411 - 418.
[ 9 ]Pu S, Wang K, Liu Y, et al.Nomogram - derived prediction of pathologic complete response (pCR) in breast cancer patients treated with neoadjuvant chemotherapy (NCT)[J]. BMC Cancer, 2020, 20(1): 1120.
[ 10 ]Wu L, Tsilimigras DI, Farooq A, et al. Potential survival benefit of radiofrequency ablation for small solitary intrahepatic cholangiocarcinoma in nonsurgically managed patients: A population - based analysis[J]. Journal of Surgical Oncology, 2019, 120(8): 1358 - 1364.
[ 11 ]Aishima S, Oda Y. Pathogenesis and classification of intrahepatic cholangiocarcinoma: different characters of perihilar large duct type versus peripheral small duct type[J]. Journal of Hepato - Biliary - Pancreatic Sciences, 2015, 22(2): 94 - 100.
[ 12 ]Hwang S, Lee YJ, Song GW, et al. Prognostic impact of tumor growth type on 7th AJCC staging system for intrahepatic cholangiocarcinoma: a Single - Center experience of 659 cases[J]. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 2015, 19(7): 1291 - 1304.
[ 13 ]Weber SM, Ribero D, O’reilly EM, et al. Intrahepatic cholangiocarcinoma: expert consensus statement[J]. HPB : the Official Journal of the International Hepato Pancreato Biliary Association, 2015, 17(8): 669 - 680.
[ 14 ]赵向前，梁斌，张航宇，等．肿块型肝内胆管细胞癌手术切除预后影响因素分析[J]．中华肝脏外科手术学电子杂志，2019，8（1）：26 - 30．Zhao XQ, Liang B, Zhang HY, et al. Analysis of prognostic impact factors of patients with mass - forming intrahepatic cholangiocarcinoma after surgical resection[J]. Chinese Journal of Hepatic Surgery, 2019, 8(1): 26 - 30.
[ 15 ]Altman AM, Kizy S, Marmor S, et al. Current survival and treatment trends for surgically resected intrahepatic cholangiocarcinoma in the United States[J]. Journal of Gastrointestinal Oncology, 2018, 9(5): 942 - 952.
[ 16 ]Merath K, Chen Q, Bagante F, et al. A multi - institutional international analysis of textbook outcomes among patients undergoing Curative - Intent resection of intrahepatic cholangiocarcinoma[J]. JAMA Surgery, 2019, 154(6): e190571.
[ 17 ]Chen L, Zeng F, Yao L, et al. Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma[J]. Cancer Medicine, 2020, 9(4): 1451 - 1461.
[ 18 ]Chan KM, Tsai CY, Yeh CN, et al. Characterization of intrahepatic cholangiocarcinoma after curative resection: outcome, prognostic factor, and recurrence[J]. BMC Gastroenterology, 2018, 18(1): 180.
[ 19 ]Kamarajah SK. Evaluation of the AJCC 8th edition staging system for pathologically versus clinically staged intrahepatic cholangiocarcinoma (iCCA): a time to revisit a dogma? a surveillance, epidemiology, and end results (SEER) analysis[J]. Journal of Gastrointestinal Cancer, 2019, 50(3): 392 - 399.
[ 20 ]Ribero D, Pinna AD, Guglielmi A, et al. Surgical approach for long - term survival of patients with intrahepatic cholangiocarcinoma: a multi - institutional analysis of 434 patients[J]. Archives of Surgery (Chicago, Ill. : 1960), 2012, 147(12): 1107 - 1113.
[ 21 ]Tsilimigras DI, Bagante F, Moris D, et al. Defining the chance of cure after resection for hepatocellular carcinoma within and beyond the Barcelona Clinic Liver Cancer guidelines: A multi - institutional analysis of 1,010 patients[J]. Surgery, 2019, 166(6): 967 - 974.
[ 22 ]Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Annals of Surgical Oncology, 2010, 17(6): 1471 - 1474.

备注/Memo

备注/Memo:

基金项目：青海省科技厅项目（2017-ZJ-936Q）；青海省临床重点建设专科（省卫医［2019］10号）
作者简介：王磊超（1994—），男，硕士，研究方向：肝胆胰疾病研究
通信作者：侯立朝，E-mail: zhuoyue_1973@163.com

常用功能

更新日期/Last Update: 2022-07-28