| Background:In clinical practice,the individual efficacy of patients with PVTT undergoing FO-HAIC differs significantly.Therefore,there is an urgent need for clinicians to screen patients suitable for FO-HAIC.Purpose:Aimed to construct a predictive model to assess individual survival outcomes of patients with HCC complicated with portal vein tumor thrombus after hepatic arterial infusion chemotherapy.Methods:A total of 283 patients with HCC complicated with portal vein tumor thrombus who underwent FO-HAIC in the Guangdong Provincial People’s Hospital and Sun Yat-sen University Cancer Center from January 2018 to Ja nuary 2023 were retrospectively included.They were allocated to training and validation cohort randomly,with 143 in the training cohort and 140 in the val idation cohort.Univariate and multivariate analyses were performed using Cox proportional hazards models to screen out the independent indicators associated with prognosis in the training cohort.Based on multivariate Cox regression an alyses,a prognostic model was developed to stratify the prognostic risk among the target population.At the same time,a nomogram was established for the prediction of 6-month,1-year and 2-year survival rates.AUROC values,C-indic es,and calibration curves were used to evaluate the discrimination and consiste ncy of the nomogram model.Results:The median follow-up period was 10.5 months with a range of 1.0 to 52.7 months.There was no significant difference in the clinical background information,laboratory indicators,tumor related features,spleen volume,etc between the training and validation cohort(P>0.05).The median progression-free survival was 4.5 months with a range of 3.8 to 5.4 months and the median overall survival was 11.4 months with a range of 9.4 to 14.5 months in the training cohort.The median progression-free survival was 5.0 months with a range of 3.8 to 6.3 months and the median overall survival was 11.0 months with a range of 9.0 to 13.0 months in the validation cohort.The survival curve showed no difference between the training cohort and the validation cohort.Univariate analysis shows ascites,albumin-bilirubin(ALBI)grade,AFP,tumor size,tumor number,extrahepatic metastasis,spleen volume during treatment and spleen volume change were considered as independent risk factors for OS.Multivariate Cox regression revealed that spleen volume change>21.80 cm3(HR=1.85;95%CI 1.23-2.80;P=0.003),spleen volume during treatment>457.24 cm3(HR=1.65;95%CI 1.02-2.66;P=0.040),high albumin-bilirubin(ALBI)grade(HR=1.74;95%CI 1.04-2.92;P=0.032),AFP>100-400/400ng/ml(HR=1.07,95%CI 0.49-2.31;HR=1.98,95%CI 1.12-3.49;P=0.019),extrahepatic metastasis(HR=1.69;95%CI 1.11-2.58;P=0.015)were independent factors for OS after FOHAIC in HCC with PVTT.Our study finally presented the model with "SSAFE-score=0.617*Sc +0.501*SD+0.556*ALBI score+0.682*AFP+0.523*Extrahepatic metastasis".Then further selected 0.56-the third quartile of the linear predictor-as cut-off value,the SSAFE-score were differentiated two risk categories with distinct prognosis and was validated in the validation cohort,total samples,patients complicated with PVTT with the type of Vp3 and Vp3/4.The values of AUROC at 6month,1-year and 2-year were 0.72,0.72 and 0.81 respectively in the training cohort.And the values of AUROC at 6-month,1-year and 2-year were 0.60,0.57 and 0.64 respectively in the validation cohort.The C-indexs in the training and validation cohort were 0.67 and 0.59.The calibration curve showed great agreement between the predicted outcome and actual survival outcome in the nomogram constructed based on the training cohort.Conclusion:The SSAFE-score and the prognostic nomogram could be used as effective assessment tools to identify patients with HCC complicated with portal vein tumor thrombus who obtain satisfying survival benefit form FO-HAIC and provide individual survival and prognosis. |
PDF Full Text Request