| PPI对PD-1抑制剂治疗肝细胞癌效果的影响—PSM分析联合Nomogram预后预测分析 |
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| 引用本文： | 王云川,谭学林,姚建妮,袁观斗,何松青. PPI对PD-1抑制剂治疗肝细胞癌效果的影响—PSM分析联合Nomogram预后预测分析[J]. 肝胆胰外科杂志, 2023, 35(4): 204-212. DOI: 10.11952/j.issn.1007-1954.2023.04.003 |
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| 作者姓名： | 王云川 谭学林 姚建妮 袁观斗 何松青 |
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| 作者单位： | 1.广西医科大学第一附属医院 肝胆外科,2.广西医科大学 区域性高发肿瘤早期防治研究教育部重点实验室,3.广西医科大学 广西肝脏疾病免疫与代谢研究重点实验室,广西 南宁 530021 |
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| 基金项目： | 广西重点研发计划项目（2018AD03001）;广西医科大学第一附属医院临床研究攀登计划（YYZS2020020）。 |
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| 摘 要： | 目的 探讨质子泵抑制剂（PPI）对肝细胞癌（HCC）患者使用程序性细胞死亡蛋白-1（PD-1）抑制剂治疗的预后影响。方法 回顾性分析接受PD-1抑制剂治疗的148例HCC患者的临床资料,根据HCC患者PPI药物使用强度（PUD）的中位数将患者分为PPI高剂量组和低剂量组,研究PPI的使用对HCC患者总生存期（OS）的影响并分析其他可能影响生存和预后的独立危险因素,构建列线图（Nomogram）预测模型。结果 基线资料倾向性评分匹配（PSM）前,使用高剂量PPI（HR 2.32,95%CI 1.41～3.80,P=0.001）是影响接受PD-1抑制剂治疗的HCC患者OS的独立危险因素,生存曲线分析提示PPI高剂量组的HCC患者其生存时间较低剂量组短。PSM后,使用高剂量PPI（HR 2.57,95%CI 1.32～4.98,P=0.005）仍然是影响接受PD-1抑制剂治疗的HCC患者OS的独立危险因素。构建Nomogram模型预测HCC患者OS,其6、12和18个月的ROC曲线下面积（AUC）分别为0.781、0.761和0.791。在预后预测方面,Nomogram预测模型与传统肿瘤分期系统相比表现出非劣势性。结论 接受PD-1抑制剂治疗的HCC患者使用高剂量PPI提示预后更差,结合包括PPI使用情况和临床特征建立的Nomogram模型对OS具有一定预测能力。
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| 关 键 词： | 肝细胞癌 质子泵抑制剂 免疫检查点抑制剂 列线图（Nomogram） |
| 收稿时间： | 2022-07-28 |
The effect of PPI on the treatment of hepatocellular carcinoma with PD-1 inhibitors: PSM analysis combined with Nomogram prediction of the prognosis |
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| WANG Yunchuan,TAN Xuelin,YAO Jianni,YUAN Guandou,HE Songqing. The effect of PPI on the treatment of hepatocellular carcinoma with PD-1 inhibitors: PSM analysis combined with Nomogram prediction of the prognosis[J]. Journal of Hepatopancreatobiliary Surgery, 2023, 35(4): 204-212. DOI: 10.11952/j.issn.1007-1954.2023.04.003 |
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| Authors: | WANG Yunchuan TAN Xuelin YAO Jianni YUAN Guandou HE Songqing |
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| Affiliation: | 1 Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University; 2 Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Guangxi Medical University; 3 Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Guangxi Medical University; Nanning 530021, China |
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| Abstract: | Objective To investigate the effect of proton pump inhibitors (PPI) on of the prognosis of hepatocellular carcinoma (HCC) patients treated with programmed cell death-1 (PD-1) inhibitor. Methods The clinical data of 148 HCC patients who treated with PD-1 inhibitor were retrospectively analyzed. The effect of PPI on overall survival (OS) of HCC patients, and other independent risk factors that may affect survival and prognosis were analyzed to construct a Nomogram model. HCC patients were divided into high-dose PPI group and low-dose PPI group according to the median PPI use density (PUD). Results Before propensity score matching (PSM), high dose of PPI was an independent risk factor affecting OS of HCC patients with PD-1 inhibitor (HR 2.32, 95%CI 1.41-3.80, P=0.001). According to survival curve analysis, compared with the low- dose group, HCC patients in high-dose group were associated with worse outcome. After PSM, high dose of PPI was also an independent risk factor affecting OS of HCC patients with PD-1 inhibitor (HR 2.57, 95%CI 1.32- 4.98, P=0.005). A Nomogram model for prediction OS was developed, the areas under the ROC (AUC) at 6, 12 and 18 months were 0.781, 0.761 and 0.791, respectively. Compared with traditional tumor stage, the Nomogram showed non-inferiority in prediction of HCC prognosis. Conclusion For HCC patients treated with PD-1 inhibitors, the high-dose PPI suggests a worse prognosis. The clinical prediction model develeped with PPI and Nomogram model shows certain predictive ability for OS |
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| Keywords: | hepatocellular carcinoma proton pump inhibitors immune checkpoint inhibitors Nomogram |
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