■乙型肝炎表面抗原(HBsAg)清除与改善长期预后和降低并发症风险相关。我们研究的目的是确定HBsAg水平在肝癌患者TACE和序贯消融的影响。此外,我们创建了一个列线图来预测局部治疗后HBsAg水平高(≥1000U/L)的HCC患者的预后。
■本研究回顾性评估了2014年1月至2021年12月在北京佑安医院和北京地坛医院行TACE联合消融的1008例HBV-HCC患者,其中HBsAg水平较低的患者334例,HBsAg水平较高的患者674例。高HBsAg组分为训练队列(N=385),内部验证队列(N=168),和外部验证队列(N=121)。收集患者的临床病理特征,并使用Lasso-Cox回归分析确定独立危险因素,以建立列线图.通过C指数评估列线图的性能,接收机工作特性(ROC)曲线,校正曲线,以及训练和验证队列中的决策曲线分析(DCA)曲线。根据列线图的风险评分将患者分为高风险和低风险组。
■PSM后,在低HBsAg水平和高HBsAg水平组中,mRFS为28.4个月(22.1-34.7个月)和21.9个月(18.5-25.4个月)(P<0.001)。列线图的内容包括年龄,BCLC阶段,肿瘤大小,球蛋白,GGT,和胆汁酸。C指数(0.682、0.666和0.740)和1-,3-,和5年的AUC培训,内部验证,和外部验证队列证明了对列线图的良好区分。校准曲线和DCA曲线表明准确性和净临床获益率。列线图能够根据复发风险将高HBsAg水平的患者分为低风险和高风险组。训练中两组间的RFS差异有统计学意义,内部验证,和外部验证队列(P<0.001)。
■高水平的HBsAg与肿瘤进展相关。在研究中开发和验证的列线图对高HBsAg水平的患者具有良好的预测能力。
Hepatitis B surface antigen (HBsAg) clearance is associated with improved long-term outcomes and reduced risk of complications. The aim of our study was to identify the effects of levels of HBsAg in HCC patients undergoing
TACE and sequential ablation. In addition, we created a nomogram to predict the prognosis of HCC patients with high levels of HBsAg (≥1000U/L) after local treatment.
This study retrospectively evaluated 1008 HBV-HCC patients who underwent
TACE combined with ablation at Beijing Youan Hospital and Beijing Ditan Hospital from January 2014 to December 2021, including 334 patients with low HBsAg levels and 674 patients with high HBsAg levels. The high HBsAg group was divided into the training cohort (N=385), internal validation cohort (N=168), and external validation cohort (N=121). The clinical and pathological features of patients were collected, and independent risk factors were identified using Lasso-Cox regression analysis for developing a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves in the training and validation cohorts. Patients were classified into high-risk and low-risk groups based on the risk scores of the nomogram.
After PSM, mRFS was 28.4 months (22.1-34.7 months) and 21.9 months (18.5-25.4 months) in the low HBsAg level and high HBsAg level groups (P<0.001). The content of the nomogram includes age, BCLC stage, tumor size, globulin, GGT, and bile acids. The C-index (0.682, 0.666, and 0.740) and 1-, 3-, and 5-year AUCs of the training, internal validation, and external validation cohorts proved good discrimination of the nomogram. Calibration curves and DCA curves suggested accuracy and net clinical benefit rates. The nomogram enabled to classification of patients with high HBsAg levels into low-risk and high-risk groups according to the risk of recurrence. There was a statistically significant difference in RFS between the two groups in the training, internal validation, and external validation cohorts (P<0.001).
High levels of HBsAg were associated with tumor progression. The nomogram developed and validated in the study had good predictive ability for patients with high HBsAg levels.