CLINICOPATHOLOGIC FEATURES AND DIAGNOSISOF COMBINED HEPATOCELLULAR ANDCHOLANGIOCARCINOMA

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＦＥＡＴＵＲＥＳＡＮＤＤＩＡＧＮＯＳＩＳＯＦＣＯＭＢＩＮＥＤＨＥＰＡＴＯＣＥＬＬＵＬＡＲＡＮＤＣＨＯＬＡＮＧＩＯＣＡＲＣＩＮＯＭＡＬｕＪｉａｎｐｉｎｇ路建平；ＣａｉＷｅｉｍｉｎ蔡为民；ＨａｙａｓｈｉＫｅｉｋｉ１林肇辉...     

中国肝细胞癌和肝内胆管细胞癌临床诊疗情况比较研究

目的 分析中国多中心肝细胞癌(hepatocellular carcinoma,HCC)和肝内胆管细胞癌(intrahepatic cholangio-carcinoma,ICC)的临床诊疗情况,为制定肝癌防治措施提供依据.方法 研究对象来源于2016—2017年全国12个省市33家医院首次确诊/治疗的新发HCC和IC...     

A novel prognostic nomogram based on microvascular invasion and hematological biomarkers to predict survival outcome for hepatocellular carcinoma patients

PurposeThis study aimed to develop and validate a nomogram for overall survival (OS) prediction in which combine clinical characteristics and hematological biomarkers in patients with hepatocellular carcinoma (HCC).MethodsWe performed a retrospective analysis of 807 HCC patients. All the clinical data of these patients were collected through electronic medical record (EMR). The independent predictive variables were identified by cox regression analysis. We tested the accuracy of the nomograms by discrimination and calibration, and then plotted decision curves to assess the benefits of nomogram-assisted decisions in a clinical context, and compared with the TNM staging systems and microvascular invasion (MVI) on HCC prognosis.ResultsThe primary cohort consisted of 545 patients with clinicopathologically diagnosed with HCC from 2008 to 2013, while 262 patients from 2014 to 2016 in external validation cohort. Variables included in the nomograms were TNM Stage, microvascular invasion (MVI), alpha fetoprotein (AFP), platelet to lymphocyte ratio (PLR) and prothrombin time (PT). The C-index of nomogram was 0.768, which was superior than the C-index of TNM Stage (0.660, P < 0.001) and MVI(0.664, P < 0.001) alone in the primary cohort. In the validation cohort, the models had a C-index of 0.845, and were also statistically higher when compared to C-index values for TNM Stage (0.687, P < 0.001) and MVI(0.684, P < 0.001). Calibration curves showed adequate calibration of predicted and reported OS prediction throughout the range of HCC outcomes. Decision curve analysis demonstrated that the nomogram was clinically useful than the TNM Stage and MVI alone. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and a high risk group, respectively.ConclusionThe nomogram presents more accurate and useful prognostic power, which could be used to predict OS for patients with HCC.     

Effect of liver fibrosis on survival in patients with intrahepatic cholangiocarcinoma: a SEER population-based study

Background: Intrahepatic cholangiocarcinoma (iCCA) is a biliary tract malignancy with rising incidence in recent decades. While the causative role of cirrhosis in the development of iCCA is well established, the role of cirrhosis as a prognostic factor in iCCA is debatable.Materials and Methods: The study population consisted of 512 patients diagnosed with iCCA between 2004–2016 collected from the Surveillance, Epidemiology and End Results (SEER) database. The impact of fibrosis on overall and cancer-specific survival 12, 36 and 60 months following diagnosis, was evaluated in the entire cohort and in sub-groups stratified according to treatment approach and the American Joint Committee on Cancer (AJCC) tumor stage using a Cox proportional-hazards model.Results: After adjusting for age, sex, race, year of diagnosis, AJCC stage, and surgical treatment strategy, advanced fibrosis was associated with worse cancer-specific survival across follow up periods (HR 1.49 (1.13–1.96, p = 0.005); HR 1.44 (1.14–1.83, p = 0.002) and HR 1.45 (1.15–1.83, p = 0.002) for 12, 36 and 60 months, respectively). Similar effects were observed for overall survival. Among patients that underwent surgical resection, advanced fibrosis was associated with worse overall survival and cancer-specific survival across follow up periods. Fibrosis was associated with worse overall and cancer-specific survival in patients with a later stage (III–IV) at diagnosis but this effect was not demonstrated in early stages.Conclusions: Patients with iCCA and advanced liver fibrosis have an increased risk of both overall and cancer-specific mortality compared to patients with earlier stages of fibrosis.     

基于SEER数据库的炎性乳腺癌生存预测风险模型的建立与验证

目的:建立可预测炎性乳腺癌(inflammatory breast cancer,IBC)生存情况的风险模型.方法:利用监测、流行病学和结果(Surveillance,Epidemiology and End Results,SEER)数据库,筛选2010年至2015年诊断为IBC的病例,通过单因素和Logistic多...     

Transarterial chemoembolization combined with recombinant human adenovirus type 5 H101 prolongs overall survival of patients with intermediate to advanced hepatocellular carcinoma:a prognostic nomogram study

Background: Patients with intermediate to advanced hepatocellular carcinoma (HCC) are most commonly treated with transarterial chemoembolization (TACE). Previous studies showed that TACE combined with recombinant human adenovirus type 5 (H101) may provide a clinical survival benefit. In the present study, we aimed to determine the survival benefit of TACE with or without H101 for patients with intermediate to advanced HCC and to develop an effective nomogram for predicting individual survival outcomes of these patients. Methods: We retrospectively collected data from 590 patients with intermediate to advanced HCC who were treated at Sun Yat-sen University Cancer Center between January 2007 and July 2015. After propensity score matching, 238 patients who received TACE with H101 (TACE with H101 group) and 238 patients who received TACE without H101 (TACE group) were analyzed. Overall survival (OS) was evaluated using the Kaplan–Meier method; the nomogram was developed based on Cox regression analysis. Discrimination and calibration were measured using the concordance index (c-index) and calibration plots. Results: Clinical and radiologic features were similar between the two groups. OS rates were significantly lower in the TACE group than in the TACE with H101 group (1-year OS rate, 53.8% vs. 61.3%; 2-year OS rate, 33.4% vs. 44.2%;3-year OS rate, 22.4% vs. 40.5%; all P < 0.05). Multivariate Cox regression analysis for the entire cohort showed that alpha-fetoprotein level, alkaline phosphatase level, tumor size, metastasis, vascular invasion, and TACE with or without H101 were independent factors for OS, all of which were included in the nomogram. Calibration curves showed good agreement between nomogram-predicted survival and observed survival. The c-index of the nomogram for predict-ing OS was 0.716 (95% confidence interval 0.686–0.746). Conclusions: TACE plus H101 extends the survival of patients with intermediate to advanced HCC. Our proposed nomogram provides individual survival prediction and stratification for patients with intermediate to advanced HCC who receive TACE with or without H101.     

A simple and effective prognostic staging system based on clinicopathologic features of intrahepatic cholangiocarcinoma

Incidence and mortality of intrahepatic cholangiocarcinoma (ICC) are increasing. However, its prognostic predictive system associated with outcome after surgery remains poorly defined. In this study, we conducted retrospective survival analyses in a primary cohort of 370 patients who underwent partial hepatectomy for ICC (2005 and 2009). We found that seven variables were significantly independent predictors for overall survival (OS): serum prealbumin (hazard ratio [HR]: 1.447; p = 0.015), carbohydrate antigen 19-9 (HR: 1.438; p = 0.009), carcinoembryonic antigen (HR: 1.732; p = 0.002), tumor number (HR: 1.781; p < 0.001), vascular invasion (HR: 1.784; p < 0.001), regional lymphatic metastasis (HR: 2.003; p < 0.001) and local extrahepatic metastasis (HR: 1.506; p = 0.008). Using these independent predictors, we created a simple clinicopathologic prognostic staging system for predicting survival of ICC patients after resection. The validity of the prognostic staging system was prospectively assessed in 115 patients who underwent partial hepatectomy between January 2010 and December 2010 at the same institution. The prognostic power was quantified using likelihood ratio test and Akaike information criteria. Compared with the 6^th and 7^th AJCC staging systems, the new staging system in the primary cohort had a higher predictive accuracy for OS in terms of homogeneity and discriminatory ability. In the validation cohort, the homogeneity and discrimination of the new staging system were also superior to the two other staging systems. Conclusions: The new staging system based on clinicopathologic features may provide relatively higher accuracy in prognostic prediction for ICC patients after tumor resection.     

基于SEER数据库绘制列线图分析软骨肉瘤患者预后相关因素

目的:分析软骨肉瘤流行病学特征及影响预后的相关因素,并且绘制列线图来个体化预测患者远期生存率。方法:收集SEER数据库2004至2015年诊断的1 453例软骨肉瘤患者的临床数据,回顾性分析软骨肉瘤患者流行病学特征及影响患者预后的相关危险因素,使用随机数字表法将所有纳入对象以7∶3分为建模组（1 017例）和验证组（436例）并构建列线图进行内部验证,预测软骨肉瘤患者3年、5年的生存率,使用多因素COX风险比例模型来确定独立因素,采用一致性指数(C-index)及校准曲线评估该预测模型的准确性。结果:软骨肉瘤患者男女性别比为:1.23∶1,年龄≥50岁患者占比为55.7%,最常见的发病部位是下肢骨,多因素分析提示,影响软骨肉瘤患者预后的因素包括年龄、性别、肿瘤原发部位、肿瘤大小、病理分级、AJCC TNM分期、手术方式、是否化疗、肿瘤大小;建模组与验证组1、3、5年ROC曲线AUC值分别为:0.87、0.838、0.807,0.864、0.754、0.755;列线图C-index指数为:0.805。结论:列线图可以准确预测软骨肉瘤患者生存率,具有较好的预测精度,有助于对患者进行个性化的预后评估和指导临床决策。     

A prognostic fingerprint in liver transplantation for hepatocellular carcinoma based on plasma metabolomics profiling

IntroductionTumor recurrence is a major cause of post-transplant mortality in liver transplantation for hepatocellular carcinoma (HCC). This study aimed to explore an effective noninvasive approach to accurately predict post-transplant tumor recurrence.Materials and methodsMetabolomics profiling was performed on pre-operative plasma from 122 HCC patients undergoing liver transplantation, 52 healthy controls (HC) and 25 liver cirrhosis (LC) patients.ResultsFive prognostic metabolites were identified by univariate analysis (P < 0.01), including phosphatidylcholine (PC) (16:0/P-18:1), PC(18:2/OH-16:0), PC(o-16:0/20:4), nutriacholic acid and 2-oxo-4-methylthiobutanoic acid. In the HCC group, PC(o-16:0/20:4), nutriacholic acid and 2-oxo-4-methylthiobutanoic acid were decreased, while PC(18:2/OH-16:0) was elevated compared with the LC group (e < 0.05). PC(16:0/P-18:1) was associated with tumor size, vascular invasion, and neutrophil-lymphocyte ratio (NLR; P < 0.05). Moreover, PC(18:2/OH-16:0) was also related to tumor number and NLR (P < 0.05). Multivariate cox regression showed that PC(16:0/P-18:1), PC(18:2/OH-16:0), nutriacholic acid and alpha-fetoprotein (AFP) were independent risk factors for tumor recurrence (P < 0.01). A prognostic fingerprint was established as a nomogram, which divided the patients into low risk (n = 45), moderate risk (n = 48) and highrisk groups (n = 29) with discriminated prognosis (P < 0.001). In patients fulfilling the Hangzhou criteria, the fingerprint/nomogram could also successfully stratify the patients into two groups with different recurrence risk (P < 0.05).ConclusionsThe established pre-operative plasma fingerprint/nomogram is efficient in the prediction of recurrence risk, which could facilitate candidate selection in liver transplantation for HCC.     

乳腺癌骨转移患者临床病理特征及预后影响因素分析：基于SEER数据库的回顾性研究

目的探讨乳腺癌骨转移患者的临床病理特征,并分析其预后情况及相关影响因素。 方法根据纳入及排除标准,利用美国国立癌症研究所监测、流行病学和结果(SEER)数据库检索并筛选1975年1月至2016年12月5 815例转移性乳腺癌患者资料进行回顾性分析,评估了患者临床病理特征、治疗方式及其预后。其中,乳腺癌骨转移组3 146例,乳腺癌非骨转移组2 669例。按照预后情况,将3 146例乳腺癌骨转移患者分为2个亚组：死亡组1 669例和存活组1 477例。利用χ²检验和Mann-Whitney U检验比较骨转移和非骨转移组患者临床病理特征的差异;用二元Logistic回归分析乳腺癌骨转移的影响因素;用Kaplan-Meier法进行生存分析,并用单因素log-rank检验分析乳腺癌骨转移患者中死亡组与存活组临床病理特征的差异;用多因素Cox比例风险回归模型筛选影响乳腺癌骨转移者生存情况的独立因素。 结果骨转移组和非骨转移组患者在T分期、N分期、组织学分级、人种、ER、PR、HER-2、肿瘤分子分型和预后方面比较,差异均有统计学意义(Z＝-5.71、-2.39、-13.87、χ²＝14.55、305.74、245.56、69.34、335.36、79.15,P均<0.050),2组间年龄、性别和原发灶位置比较,差异均无统计学意义(χ²＝0.57、2.71、0.45,P均>0.050)。Logistic回归分析结果显示：ER阳性、PR阳性、肿瘤T分期高和N分期高为导致乳腺癌患者骨转移的危险因素(OR＝1.775,95%CI：1.258～2.505,P＝0.001;OR＝1.425,95%CI: 1.236～1.643,P<0.001;OR＝1.095,95%CI：1.043～1.149,P<0.001;OR＝1.396,95%CI: 1.246～1.564,P<0.001),而组织学分级越高,发生骨转移的风险反而越小(OR＝0.815,95%CI：0.733～0.907,P<0.001)。骨转移组与非骨转移组患者的OS比较,差异均具有统计学意义(χ²＝133.53,P<0.001)。骨转移患者中,2个亚组(死亡组和存活组)患者在T分期、N分期、组织学分级、年龄、ER、PR、HER-2、肿瘤分子分型、原发灶手术、放射治疗和化疗方面比较,差异均有统计学意义(Z＝-7.75、-3.22、-8.14、χ²＝39.80、69.81、87.45、51.87、132.47、36.24、6.05、36.24,P均<0.050)。Cox比例风险回归模型多因素分析结果显示：年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级、化疗、放射治疗和原发灶手术是影响骨转移组患者预后的独立因素(HR＝1.349,95%CI: 1.195～1.523,P<0.001;HR＝1.151,95%CI: 1.101～1.203,P<0.001;HR＝ 1.077,95%CI: 1.033～1.123,P<0.001;HR＝ 0.715,95%CI: 0.626～0.817,P<0.001;HR＝0.695,95%CI: 0.627～0.770,P<0.001;HR＝1.349,95%CI: 1.260～1.414,P<0.001;HR＝1.371,95%CI: 1.261～1.489,P<0.001;HR＝0.626,95%CI：0.562～0.697,P<0.001;HR＝0.874,95%CI：0.791～0.966,P＝0.008;HR＝0.663,95%CI: 0.561～0.784,P<0.001)。 结论乳腺癌骨转移患者预后优于非骨转移患者,与年龄、T分期、N分期、PR、HER-2、肿瘤分子分型、组织学分级有关,治疗方面原发灶手术、放射治疗和化疗有助于改善骨转移患者的预后。     

Development and validation of a nomogram for prediction of survival and local control in laryngeal carcinoma patients treated with radiotherapy alone: A cohort study based on 994 patients

Introduction

To advise laryngeal carcinoma patients on the most appropriate form of treatment, a tool to predict survival and local control is needed.

Materials and methods

We performed a population-based cohort study on 994 laryngeal carcinoma patients, treated with RT from 1977 until 2008. Two nomograms were developed and validated. Performance of the models is expressed as the Area Under the Curve (AUC).

Results

Unfavorable prognostic factors for overall survival were low hemoglobin level, male sex, high T-status, nodal involvement, older age, lower EQD_2T (total radiation dose corrected for fraction dose and overall treatment time), and non-glottic tumor. All factors except tumor location were prognostic for local control. The AUCs were 0.73 for overall survival and 0.67 for local control. External validation of the survival model yielded AUCs of 0.68, 0.74, 0.76 and 0.71 for the Leuven (n = 109), the VU Amsterdam (n = 178), the Manchester (n = 403) and the NKI cohort (n = 205), respectively, while the validation procedure for the local control model resulted in AUCs of 0.70, 0.71, 0.72 and 0.62. The resulting nomograms were made available on the website www.predictcancer.org.

Conclusions

For patients with a laryngeal carcinoma treated with RT alone, we have developed visual, easy-to-use nomograms for the prediction of overall survival and primary local control. These models have been successfully validated in four external centers.     

Prognostic value of lymphadenectomy in node-negative intrahepatic cholangiocarcinoma: A multicenter,retrospectively study

BackgroundThis study aimed to evaluate the prognostic value of lymph node dissection (LND) in node-negative intrahepatic cholangiocarcinoma (ICC) and identify the appropriately total number of lymph nodes examined (TNLE).MethodsData from node-negative ICC patients who underwent curative intent resection in ten Chinese hepatobiliary centers from January 2010 to December 2018 were collected. Overall survival (OS), relapse-free survival (RFS) and postoperative complications were analyzed. Propensity score matching (PSM) was performed to reduce the bias due to confounding variables in LND group and non-lymph node dissection (NLND) group. The optimal TNLE was determined by survival analysis performed by the X-tile program using the enumeration method.ResultsA total of 637 clinically node-negative ICC patients were included in this study, 74 cases were found lymph node (LN) positive after operation. Among the remaining 563 node-negative ICC patients, LND was associated with longer OS but not RFS before PSM (OS: 35.4 vs 26.0 months, p = 0.047; RFS: 15.0 vs 15.4 months, p = 0.992). After PSM, patients in LND group had better prognosis on both OS and RFS (OS: 38.0 vs 23.0 months, p < 0.001; RFS: 15.0 vs 13.0 months, p = 0.029). There were no statistically differences in postoperative complications. When TNLE was greater than 8, OS (48.5 vs 31.1 months, p = 0.025) and RFS (21.0 vs 13.0 months, p = 0.043) were longer in the group with more dissected LNs.ConclusionRoutinely LND for node-negative ICC patients is recommended for it helps accurate tumor staging and associates with better prognosis. The optimal TNLE is more than 8.     

Paget's病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究

目的:分析佩吉特氏病伴浸润性导管癌（Paget's disease with invasive ductal carcinoma,PD-IDC）患者的临床病理特征、治疗和预后情况。方法:通过美国 SEER*Stat 软件搜集2010至2014年病理明确诊断为PD-IDC及浸润性乳腺癌（invasive ductal carcinoma,IDC）并接受手术治疗的患者分别550例和207 221例。用SPSS 21.0进行统计学分析和绘制生存曲线。结果:与IDC相比,PD-IDC患者男性乳腺癌比例更大,可能有更大的体积、更多的淋巴结受累、更高级别以及更晚期的肿瘤（P均<0.05）;且更可能是激素受体（HR）阴性［ER阴性（37.3% vs 18.5%）、PR阴性（52.0% vs 28.5%）］和Her-2阳性（53.3% vs 15.4%）;在治疗方案中更有可能接受乳房切除术（85.8% vs 43.9%）和腋窝淋巴结清扫术（45.1% vs 29.5%）（P均<0.05）;但预后更差,死亡率更高,且乳腺癌相关死亡率（BCSM）更高。此外,Cox回归分析显示肿瘤分级和Her-2状态与PD-IDC患者的总生存时间（OS）显著相关（P<0.05）,而患者性别和肿瘤分级与PD-IDC患者的BCSM相关（P<0.05）,且Her-2阳性者相较于阴性者（OS:HR=0.019,P=0.009;BCSM:HR=0.000,P=0.623）与PD-IDC患者的OS显著相关,淋巴结手术方式也与PD-IDC患者的OS有一定的相关性。结论:与IDC相比,PD-IDC患者更可能是HR阴性和Her-2阳性且预后较差。同时,淋巴结的处理在PD-IDC的治疗中有一定的必要性。     

Comprehensive analysis of an autophagy-related prognostic model for predicting survival based on TCGA and ICGC database in hepatocellular carcinoma patients

BackgroundThere is accumulating evidence that autophagic activity is crucial to the development of hepatocellular carcinoma (HCC). Thus, we sought to develop a predictive model based on autophagy-related genes (ARGs) to forecast the prognosis of HCC patients.MethodsBased on expression data from The Cancer Genome Atlas (TCGA) and ARGs from Human Autophagy Database (HADb), the differentially expressed ARGs were screened. The prognosis-related ARGs were identified using a univariate Cox regression analysis. Using multivariate Cox regression analysis, a prognostic model was developed. To assess the predictive value of the model, receiver operating characteristic (ROC) curve, Kaplan-Meier curve, and multivariable Cox regression analyses were conducted. A data cohort gathered independently from the International Cancer Genome Consortium (ICGC) database further verified the model’s predictive accuracy. The immune landscape was generated using the TIMER and CIBERSORT algorithms. Finally, the correlation between the prognostic signature and gene mutation status was analyzed by employing “maftools” package.ResultsWe identified a novel prediction model based on the ARGs of PLD1 and SLC36A1 with significant prognostic values for HCC in both univariate and multivariate Cox regression analysis, and patients were classified into high- or low-risk groups based on their risk scores. High-risk patients had significantly shorter overall survival (OS) times than low-risk patients (P=5e-4). According to the ROC curve analysis, the risk score had a higher predictive value than the other clinical characteristics. Prognostic nomograms were also performed to visualize the relationship between individual predictors and survival rates in patients with HCC. Further, an external independent cohort of ICGC patients provided additional confirmation of the predictive efficacy of the model. We subsequently analyzed the differential immune densities of the two groups and discovered that various immune cells, including naïve B cells, resting memory cluster of differentiation (CD)4 T cells, regulatory T cells, M2 macrophages, and neutrophils, had considerably larger infiltrating densities in the high-risk group than the low-risk group.ConclusionsWe established a robust autophagy-related risk model having a certain prediction accuracy for predicting the prognosis of HCC patients. Our findings will contribute to the definition of prognosis and establishment of personalized treatment interventions for HCC patients.     

甲状腺微小乳头状癌外科手术方式趋势及相关因素分析:基于SEER数据库的回顾性研究

目的:了解甲状腺微小乳头状癌（PTMC）外科手术方式的趋势,分析可能影响手术方式选择的相关因素。方法:提取美国SEER数据库2004年至2014年病理诊断为PTMC患者的病例资料,回顾性分析甲状腺和区域淋巴结外科手术方式的趋势及相关因素。甲状腺手术方式分为甲状腺全/近全切除术和甲状腺非全切除术,区域淋巴结手术方式分为清扫和未清扫。结果:32 984例患者纳入分析,中位年龄49岁（IQR:23~76岁）,男性占17.15%,女性占82.85%。甲状腺手术方式全/近全切除率从2004年的72.43%逐渐增至2012年的79.90%,甲状腺非全切除比例从2004年的27.46%逐渐降至2012年的20.05%。患者年龄、性别、病灶数和肿瘤分期与甲状腺手术方式的选择显著相关（P＜0.001）。区域淋巴结的清扫比例从2004年的34.10%逐渐增至2012年的44.54%,未清扫比例从2004年的64.68%逐渐降至2011年的54.43%。区域淋巴结手术方式与年龄、病灶数和肿瘤分期密切相关（P＜0.001）,与性别无相关性（P=0.053）。结论:PTMC患者甲状腺全/近全切除比例和区域淋巴结清扫比例呈增加趋势,应根据患者的肿瘤特性、疾病分期和复发分层选择手术方式。     

Clinical features,treatment, and prognosis of different histological types of primary small bowel adenocarcinoma: A propensity score matching analysis based on the SEER database

PurposeThis aim of this study was to provide a comprehensive understanding of the clinical characteristics, treatment, and prognosis of patients with small bowel adenocarcinoma (SBA), mucinous small bowel adenocarcinoma (MSBA), and signet ring cell carcinoma of the small bowel (SRCSB).MethodsInformation on patients with SBA, MSBA, and SRCSB (2004–2015) was obtained from the Surveillance, Epidemiology and End Results (SEER) database. Cox proportional hazards models and Kaplan–Meier curves were used for the survival analyses. Propensity-score matching (PSM) was implemented to determine the differences among these tumors.ResultsIn all, 3697 patients with SBA (n = 3196), MSBA (n = 325) and SRCSB (n = 176) were ultimately eligible for this study. Poor differentiation, local invasion, and lymph node metastasis were more likely to be observed in SRCSB than in SBA and MSBA. Surgery was the most common treatment modality in all groups. The prognosis of SBA was similar to that of MSBA, but better than that of SRCSB in both unmatched and matched cohorts. M stage, surgery, and chemotherapy were identified as independent predictors of survival in all patients. Surgery and chemotherapy could significantly improve outcomes in all groups before and after PSM. Radiotherapy was associated with a survival benefit in patients with SBA, but this trend was not maintained after PSM. Survival advantages of SBA and MSBA were remarkable in the stratified analysis of surgery after PSM.ConclusionPatients with SRCSB had the worst prognosis among all histological types examined. However, surgery and chemotherapy could improve patients survival, regardless of histological type.     

A multicenter retrospective study on clinical characteristics, treatment patterns, and outcome in elderly patients with hepatocellular carcinoma

Background.

There is a paucity of information on the clinical presentation and outcome of elderly hepatocellular carcinoma (HCC) patients. We performed a multicenter retrospective comparative study to assess the impact of age on potential differences in clinical characteristics, treatment patterns, and outcome in HCC patients.

Methods.

We retrospectively analyzed HCC patients treated at two U.S. tertiary institutions from 1998 to 2008. Demographics, tumor parameters, etiology and severity of cirrhosis, treatment, and survival from diagnosis were collected and analyzed. After exclusion of transplanted patients, survival analyses were performed using the Kaplan-Meier method with log-rank tests and Cox proportional hazards models.

Results.

Three hundred thirty-five HCC patients were divided into two groups: “elderly” (95 patients, age ≥70 years) and “younger” (240 patients, aged <70 years). The male/female (M/F) ratio was 5.8:1 and 1.7:1 in the younger and elderly groups, respectively (p < .0001). Hepatitis C virus (HCV) infection rate was 48.3% in younger and 21.1% in elderly patients (p < .0001); Child class B and C cirrhosis accounted for 35.8% in younger and 25.3% in elderly patients (p = .063). Compared with younger patients, the elderly received transplant less frequently (19.6% versus 5.3%, p = .0002) and were more likely to receive supportive care only (22.9% versus 36.8%, p = .01). No significant differences between the two age groups were seen in tumor parameters or other treatments received. Overall (p = .47) and HCC-specific survival rates (p = .38) were similar in both age groups.

Conclusions.

Characteristics that distinguish elderly from younger HCC patients include lower M/F ratio, worse performance status, lower rate of HCV infection, and less advanced underlying cirrhosis. Elderly patients were less likely to have a liver transplant and more likely to receive supportive care only. However, overall and HCC-specific survival were similar between the two groups.     

Development and validation of an XGBoost model to predict 5-year survival in elderly patients with intrahepatic cholangiocarcinoma after surgery: a SEER-based study

BackgroundNomograms have been established to predict survival in postoperative or elderly intrahepatic cholangiocarcinoma (ICC) patients. There are no models to predict postoperative survival in elderly ICC patients. Extreme gradient boosting (XGBoost) can adjust the errors generated by existing models. This retrospective cohort study aimed to develop and validate an XGBoost model to predict postoperative 5-year survival in elderly ICC patients.MethodsThe Surveillance, Epidemiology, and End Results (SEER) program provided data on elderly ICC patients aged 60 years or older and undergoing surgery. The median follow-up time was 20 months. Totally 1,055 patients were classified as training (n=738) and testing (n=317) sets at a ratio of 7:3. The outcome was postoperative 5-year survival. Demographic, tumor-related and treatment-related variables were collected. Variables were screened using the XGBoost model. The predictive performance of the model was assessed by the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kaplan-Meier curve. Cox regression analysis was conducted to estimate the risk of death in the predicted populations. The predictive abilities of the XGBoost model and the American Joint Commission on Cancer (AJCC) system (7th edition) were compared.ResultsThe XGBoost model achieved an AUC of 0.811, a sensitivity of 0.573, a specificity of 0.890, and a PPV of 0.849 in the training set. In the testing set, the model had an AUC of 0.713, a sensitivity of 0.478, a specificity of 0.814, and a PPV of 0.726. The 5-year mortality risk of patients predicted to die was 2.91 times that of patients predicted to survive [hazard ratio (HR) =2.91, 95% confidence interval (CI): 2.42–3.50]. The XGBoost model showed a better predictive performance than the AJCC staging system both in the training and testing sets. AJCC stage, multiple (satellite) tumors/nodules, tumor-node-metastasis (TNM) stage, more than one lobe invaded, direct invasion of adjacent organs, tumor size, and radiotherapy were relatively important features in survival prediction.ConclusionsThe XGBoost model exhibited some predictive capacity, which may be applied to predict postoperative 5-year survival for elderly ICC patients.     

基于列线图构建和验证肝细胞癌伴门静脉癌栓患者肝切除术后的预后评估模型

目的 分析影响肝细胞癌伴门静脉癌栓（PVTT-HCC）患者肝切除术后预后的影响因素,并基于列线图模型构建和验证预后评估模型。方法 本研究为回顾性队列研究,选择2008年1月—2017年11月在本院行肝切除术的PVTT-HCC患者为研究对象,随访截至2021年1月。主要预测结局为1、3、5年总生存率。按照7∶3的比例将患者随机分为训练集和验证集,在训练集中采用Cox比例风险回归分析影响预后的影响,并基于影响因素构建列线图模型。同时在训练集和验证集中采用C-index评价模型的区分度,一致性曲线评估模型的校准度。结果 共231例患者符合纳入排除标准纳入分析,其中训练集162例,验证集69例。Cox比例风险回归模型显示,AFP≥400 μg/L、AST≥40 U/L、ALP≥80 U/L、肿瘤个数>1个及肿瘤包膜不完整是影响预后的危险因素。在训练集中,列线图模型预测1、3、5年总生存率的C-index分别为0.826（95%CI: 0.791~0.861）、0.818（95%CI：0.782~0.854）、0.781（95%CI：0.742~0.820）,在验证集中分别为0.814（95%CI：0.777~0.851）、0.798（95%CI：0.758~0.837）、0.769（95%CI：0.728~0.810）。校正曲线显示列线图模型在训练集和验证集均有较好的校准度。结论 本研究构建的列线图模型可准确预测PVTT-HCC患者的预后。