HBV相关肝内胆管癌术后实际长期生存预测模型的建立

摘要/Abstract

摘要： 目的探讨HBV相关肝内胆管癌(ICC)术后实际长期生存的影响因素并构建预测生存的列线图。方法收集2011年1月至2014年12月在海军军医大学第三附属医院接受手术的HBV相关ICC患者临床病理资料以及随访数据。根据实际长期生存时间(5年)将患者分为长生存组和短生存组。比较两组患者的临床资料。单因素和多因素回归分析与实际长期生存相关的独立危险因素。建立列线图,在验证组中验证模型效能。结果共纳入508例患者,生存曲线精算长期生存率为23.4%,排除59例末次随访状态为存活而随访时间不足5年的患者后,术后存活超过5年的患者有85例,术后5年内死亡的患者有364例,实际长期生存率为18.9%。多因素回归分析显示,HBV DNA＞2000 IU/mL、CA19-9、肿瘤最大径＞5 cm、肿瘤多发、周围组织侵犯、血管侵犯、淋巴结转移是影响患者实际长期生存的独立危险因素,根据独立危险因素建立的列线图模型一致性指数在模型组和验证组分别为0.831(95%CI:0.786~0.876)、0.804(95%CI:0.702~0.906),且模型预测曲线与校准后预测曲线接近。结论长期生存的患者HBV DNA和CA19-9水平更低,单发肿瘤且直径<5 cm、无周围组织侵犯、血管侵犯和淋巴结转移的占比也更低。通过独立危险因素构建的列线图可较好地预测HBV相关ICC术后长期生存。

关键词: 乙型肝炎病毒, 肝内胆管癌, 实际长期生存, 预后, 列线图

Abstract: Objective To investigate the outcomes of actual long-term survival in patients with hepatitis B virus-related intrahepatic cholangiocarcinoma (ICC) after surgical resection, identify the associated predictive factors, and to establish a nomogram for predicting survival. Methods This study was conducted on ICC patients who underwent liver resection from January 2011 to December 2014 at the eastern hepatobiliary surgery hospital. The patients were divided into a ‘long-term survivor group’ and a ‘short-term survivor group’ according to their 5-years survival. Clinical and pathological characteristics between the two groups were compared using univariate and multivariate logistic regression analyses to identify the independent factors associated with actual long-term survival and establish a predictive nomogram. The model performance was assessed in the testing group. Results A total of 508 patients were collected in this study, with an actuarial long-term survival rate of 23.4%. After excluding 59 survival patients that had less than 5 years of follow-up, 85 patients survived more than 5 years postoperatively, and 364 patients died within 5 years after liver resection, resulting in an actual long-term survival rate of 18.9%. Multivariate logistic regression analysis revealed that HBV DNA > 2000 IU/mL, CA19-9, maximum tumor diameter > 5cm, multiple tumors, peritumoral tissue invasion, vascular invasion, and lymph node metastasis were independent associated factors with patients’ actual long-term survival. The nomogram model built based on independent risk factors had a concordance index (C-index) of 0.831 (95%CI: 0.786-0.876) in the modeling group and 0.804 (95%CI: 0.702-0.906) in the testing group, with the model prediction curve closely aligning with the calibrated prediction curve. Conclusion Nearly 1/5 of patients with HBV-related ICC achieve more than 5 years of long-term survival postoperatively. Long-term survivors typically exhibit lower levels of HBV DNA and CA19-9, solitary tumor with diameter no more than 5cm, and absence of peritumoral tissue invasion, vascular invasion, and lymph node metastasis. The nomogram constructed with independent risk factors can predict long-term survival after liver resection for HBV-related ICC effectively.

Key words: Hepatitis B virus, Intrahepatic cholangiocarcinoma, Actual long-term survival, Prognosis, Nomogram

胡志亮, 李风伟, 王葵. HBV相关肝内胆管癌术后实际长期生存预测模型的建立[J]. 肝脏, 2024, 29(9): 1029-1034.

HU Zhi-liang, LI Feng-wei, WANG Kui. The establishment of a predictive model for the actual long-term survival after liver resection in hepatitis B-related intrahepatic cholangiocarcinoma[J]. Chinese Hepatolgy, 2024, 29(9): 1029-1034.

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