肝血管肉瘤预后特征及列线图的建立与验证

目的比较肝细胞癌和肝血管肉瘤患者的预后,并基于肝血管肉瘤患者人群建立并验证影响其预后的列线图模型。方法计算机检索Surveillance,Epidemiology and End Results(SEER)数据库,搜集病理学诊断确诊的肝血管肉瘤患者及肝细胞癌患者资料,检索时限为2004~2016年。将肝血管肉瘤患者和肝细胞癌患者采用倾向性评分匹配法(propensity score matching,PSM)按1∶3匹配后,采用生存分析方法比较两组的预后。在肝血管肉瘤人群中,按6∶4随机分为训练组和验证组,依据训练组样本建立列线图模型,并分别计算C指数,评估模型拟合效果。结果最终纳入肝细胞癌患者630例,肝血管肉瘤患者210例。肝细胞癌患者的三年生存率为18.4%,中位生存时间为5个月;肝血管肉瘤患者的3年生存率为6.7%,中位生存时间为1个月。肝血管肉瘤组的总生存率显著低于肝细胞癌组(P<0.001)。列线图预测模型内部验证C指数为0.751,外部验证C指数为0.737。结论肝血管肉瘤组的总生存率显著低于肝细胞癌组,依据年龄、性别、种族、转移情况、手术方式和有无化疗建立的列线图模型表现了良好的预测效果,可为预测肝血管肉瘤患者的预后提供依据。受纳入患者限制,上述结论尚待更多高质量研究予以验证。

Prognosis of hepatic angiosarcoma and establishment of predictive nomogram

Objectives To compare the survival outcomes between hepatocellular carcinoma and hepatic angiosarcoma,and to develop and validate a nomogram predicting the outcome of hepatic angiosarcoma.Methods The Surveillance,Epidemiology and End Results(SEER)database was electronically searched to collect the data of hepatic angiosarcoma patients and hepatocellular carcinoma patients from 2004 to 2016.Propensity score matching(PSM)was used to match the two groups by the ratio of 1:3.Cox regression analysis was used to compare the survival outcomes between hepatic angiosarcoma and HCC.In the angiosarcoma group,population was divided into training set and validation set by 6:4.Nomograms were built for the prediction of half-and one-year survival,and validated by concordance index(C-index)and calibration plots.Results A total of 210 histologically confirmed hepatic angiosarcoma patients and 630 hepatocellular carcinoma patients were included.The overall survival of HCC was significantly longer than angiosarcoma(3-year survival:18.4%vs.6.7%,median survival:5 months vs.1 month,P<0.001),and the nomogram achieved good accuracy with an internal C-index of 0.751 and an external C-index of 0.737.Conclusions The overall survival of HCC is significantly longer than angiosarcoma.The proposed nomograms can assist to predict survival probability in patients with hepatic angiosarcoma.Due to limitation of the data of included patients,more high-quality studies are required to verify above conclusions.