基于SEER数据库混合细胞性肝癌病人预后列线图构建与验证

目的 探讨混合细胞性肝癌（CHC）病人预后的危险因素，构建并验证列线图。 方法 回顾性收集监测、流行病学和最终结果数据库2004-2018年诊断为CHC 531例病人临床资料，随机分为训练集和验证集。使用Cox比例风险模型构建列线图，验证并比较列线图和第8版美国癌症联合委员会（AJCC）分期预测效能。 结果 肿瘤大小、治疗方式、远处转移、肿瘤分化和肝纤维化是CHC病人预后的独立危险因素（P<0.05）。列线图C-index在训练集和验证集中分别为0.777（95% CI 0.752-0.803）和0.734（95% CI 0.689-0.779），1、3、5年总生存率ROC曲线下面积（AUROC）在训练集和验证集中分别为0.845、0.873、0.854和0.790、0.871、0.871。与AJCC分期相比，列线图C-index和AUROC更高，赤池信息准则和贝叶斯信息准则更低。校准曲线显示列线图校准良好。临床决策曲线显示列线图比AJCC分期净收益更高。倾向性评分匹配后肝移植病人预后优于肝切除病人（5年总生存率：64.5% vs. 36.5%，P=0.010）。 结论 列线图能个体化预测CHC病人预后，为临床决策提供参考。CHC病人可能能从肝移植中获益，但这一结论仍需进一步研究。

Development and validation of a nomogram to predict overall survival in patients with combined hepatocellular-cholangiocarcinoma based on the SEER database

Objective To investigate the prognostic indicators and develop a nomogram to predict overall survival in patients with combined hepatocellular-cholangiocarcinoma(CHC).Methods The retrospective cohort study was conducted. The clinicopathological data of 531 CHC patients from 2004 to 2018 in the Surveillance, Epidemiology and End Results (SEER) database were collected. The study cohort was divided randomly into the training and validation set. The nomogram was developed based on the Cox regression model. Internal and external validations were performed to compare prognostic performance between the nomogram and American Joint Committee on Cancer(AJCC) staging system(8 th edition). Decision curve analysis was introduced to examine the clinical value of the models.Results Tumor size,surgery, distant metastasis, tumor grade and live cirrhosis were confirmed as the independent predictors of overall survival in CHC patients(P<0.05). The C-indexes of the nomogram were 0.777(95% CI 0.752-0.803) in the training set and0.734(95% CI 0.689-0.779) in the validation set. In both the training and validation set, the nomogram was well calibrated and it showed better discrimination power and higher net benefits than the AJCC staging system.Patients with liver transplantation showed better survival than those with hepatectomy(5-year overall survival 64.5% vs. 36.5%, P=0.010) after propensity score matching.Conclusion The constructed nomogram could predict the prognosis with good performance, meaningful to individual treatment strategies optimization. Patients with CHC should also be considered as potential liver transplantations recipients, but the finding still needs more evidence to be further confirmed.