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肝细胞癌行肝切除与经动脉化疗栓塞之间的选择:一项多中心研究-ag捕鱼平台

文字: 2020-2-29    浏览次数:409    


objectives
models should be developed to assist choice between liver resection (lr) and transarterial chemoembolization (tace) for hepatocellular carcinoma.

目的

应建立模型以评估肝细胞癌治疗选择肝切除(lr)或是经动脉化疗栓塞(tace)。

 

methods
after separating 520 cases from 5 hospitals into training (n = 302) and validation (n = 218) data sets, we weighted the cases to control baseline difference and ensured the causal effect between treatments (lr and tace) and estimated progression-free survival (pfs) difference. a noninvasive pfs model was constructed with clinical factors, radiological characteristics, and radiomic features. we compared our model with other 4 state-of-the-art models. finally, patients were classified into subgroups with and without significant pfs difference between treatments.

方法

我们将来自5家医院的520例患者分为试验组(n = 302)和验证组(n = 218)数据集,然后对这些病例进行加权以控制基线差异,并确保治疗(lr和tace)和无进展生存(pfs)差异估值之间的因果关系。结合临床因素、影像学特点和放射特征,建立无创pfs模型。将我们的模型与其他4种最先进的模型进行了比较。最后,将患者分为治疗后pfs是否存在显著性差异的亚组。

 

results
our model included treatments, age, sex, modified barcelona clinic liver cancer stage, fusion lesions, hepatocellular carcinoma capsule, and 3 radiomic features, with good discrimination and calibrations (area under the curve for 3-year pfs was 0.80 in the training data set and 0.75 in the validation data set; similar results were achieved in 1- and 2-year pfs). the model had better accuracy than the other 4 models. a nomogram was built, with different scores assigned for lr and tace. separated by the threshold of score difference between treatments, for some patients, lr provided longer pfs and might be the better option (training: hazard ratio [hr] = 0.50, p = 0.014; validation: hr = 0.52, p = 0.026); in the others, lr provided similar pfs with tace (training: hr = 0.84, p = 0.388; validation: hr = 1.14, p = 0.614). tace may be better because it was less invasive.

结果

我们的模型包括治疗方式、年龄、性别、改良的巴塞罗那临床肝癌分期、融合病变、肝细胞癌包膜和3个放射特征,具有良好的鉴别力和校正力(3年pfs曲线下面积试验组数据集为0.80,验证组数据集为0.75;在1年和2年的pfs中也获得了类似的结果)。该模型的精确度优于其他4个模型。构建一种列线图,为lr和tace分配不同的评分。以治疗间评分差异的临界值来区分,对于部分患者,lr提供更长的pfs,可能是更好的选择(试验组:hr=0.50, p=0.014;验证组:hr=0.52,p=0.026);在其他组中,lr与tace取得了相似的pfs(试验组:hr=0.84,p=0.388;验证组:hr=1.14,p=0.614)。tace可能更好,因为它的侵入性更小。

 

discussion
we propose an individualized model predicting pfs difference between lr and tace to assist in the optimal treatment choice.

讨论

我们建立了一个个体化的模型来预测lr和tace之间pfs的差异,以帮助选择最优的治疗方案。