背景:肝内胆管癌(ICC)是一种高度恶性的肿瘤,预后不良。这项研究旨在调查血红蛋白,白蛋白,淋巴细胞,血小板(HALP)评分和肿瘤负担评分(TBS)是ICC患者根治性切除术后的独立影响因素。此外,我们试图评估组合HALP和TBS等级的预测能力,称为HTS等级,并建立预后预测模型。
方法:回顾性分析行根治性切除术的ICC患者的临床资料。首次采用单因素和多因素Cox回归分析发现ICC预后的影响因素。然后使用受试者工作特征(ROC)曲线来找到HALP评分和TBS的最佳临界值,并比较HALP的预测能力。TBS,和使用这些曲线下的面积(AUC)的HTS等级。基于多变量分析结果构建并验证了列线图预测模型。
结果:在423名患者中,男性234人(55.3%),年龄≥60岁202人(47.8)。发现HALP的临界值为37.1,TBS为6.3。我们的单变量结果表明,HALP,TBS,和HTS分级是影响ICC患者预后的因素(均P<0.05),ROC结果显示HTS的预测价值最好。Kaplan-Meier曲线显示ICC患者的预后随HTS分级的增加而恶化。此外,多元回归分析表明,HTS等级,糖类抗原19-9(CA19-9),肿瘤分化,和血管侵犯是总生存期(OS)的独立影响因素,HTS分级,CA19-9,CEA,血管浸润和淋巴结浸润是无复发生存率(RFS)的独立影响因素(均P<0.05)。在第一,第二,培训小组的第三年,OS的AUC分别为0.867,0.902和0.881,RFS的AUC分别为0.849,0.841和0.899.在第一,第二,验证小组的第三年,OS的AUC分别为0.727,0.771和0.763,RFS的AUC分别为0.733,0.746和0.801.通过校正曲线的检查和使用决策曲线分析(DCA),基于HTS等级的列线图显示出优异的预测性能。
结论:我们基于HTS等级的列线图具有出色的预测效果,因此可能能够帮助临床医生为ICC患者提供个性化的临床决策。
BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is a highly malignant tumor with a poor prognosis. This
study aimed to investigate whether Hemoglobin, Albumin, Lymphocytes, and Platelets (HALP) score and Tumor Burden Score (TBS) serves as independent influencing factors following radical resection in patients with ICC. Furthermore, we sought to evaluate the predictive capacity of the combined HALP and TBS grade, referred to as HTS grade, and to develop a prognostic prediction model.
METHODS: Clinical data for ICC patients who underwent radical resection were retrospectively analyzed. Univariate and multivariate Cox regression analyses were first used to find influencing factors of prognosis for ICC. Receiver operating characteristic (ROC) curves were then used to find the optimal cut-off values for HALP score and TBS and to compare the predictive ability of HALP, TBS, and HTS grade using the area under these curves (AUC). Nomogram prediction models were constructed and validated based on the results of the multivariate analysis.
RESULTS: Among 423 patients, 234 (55.3%) were male and 202 (47.8) were aged ≥ 60 years. The cut-off value of HALP was found to be 37.1 and for TBS to be 6.3. Our univariate results showed that HALP, TBS, and HTS grade were prognostic factors of ICC patients (all P < 0.05), and ROC results showed that HTS had the best predictive value. The Kaplan-Meier curve showed that the prognosis of ICC patients was worse with increasing HTS grade. Additionally, multivariate regression analysis showed that HTS grade, carbohydrate antigen 19-9 (CA19-9), tumor differentiation, and vascular invasion were independent influencing factors for Overall survival (OS) and that HTS grade, CA19-9, CEA, vascular invasion and lymph node invasion were independent influencing factors for recurrence-free survival (RFS) (all P < 0.05). In the first, second, and third years of the training group, the AUCs for OS were 0.867, 0.902, and 0.881, and the AUCs for RFS were 0.849, 0.841, and 0.899, respectively. In the first, second, and third years of the validation group, the AUCs for OS were 0.727, 0.771, and 0.763, and the AUCs for RFS were 0.733, 0.746, and 0.801, respectively. Through the examination of calibration curves and using decision curve analysis (DCA), nomograms based on HTS grade showed excellent predictive performance.
CONCLUSIONS: Our nomograms based on HTS grade had excellent predictive effects and may thus be able to help clinicians provide individualized clinical decision for ICC patients.