基于APRI的新型预测性线形图在立体定向身体放疗治疗乙型肝

StephenW

Development and Assessment of Novel Predictive Nomograms Based on APRI for Hepatitis B Virus-associated Small Solitary Hepatocellular Carcinoma with Stereotactic Body Radiotherapy
Lin Lai  1   2 , Tingshi Su  1 , Zhongguo Liang  1 , Yunxing Lu  2 , Encun Hou  2 , Zuping Lian  2 , Hongjun Gao  3 , Xiaodong Zhu  4   1
Affiliations
Affiliations

    1
    Department of Radiotherapy, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, People's Republic of China.
    2
    Department of Medical Oncology, Ruikang Hospital Affiliated to Guangxi Traditional Chinese Medical University, Nanning 530011, Guangxi, People's Republic of China.
    3
    Department of Urology, Ruikang Hospital Affiliated to Guangxi Traditional Chinese Medical University, Nanning 530011, Guangxi, People's Republic of China.
    4
    Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning 530199, Guangxi, People's Republic of China.

    PMID: 33046985 PMCID: PMC7545675 DOI: 10.7150/jca.47291

Abstract

Background: The correlation between serum inflammatory marker before treatment and the survival of patients with hepatitis B virus (HBV)-associated small solitary hepatocellular carcinoma (HCC) after stereotactic body radiotherapy (SBRT) remains unclear. The objective of our study is to estimate survival in such patients using multivariable prediction models and investigate the prognostic value of aspartate aminotransferase-to-platelet index (APRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) for HBV-associated small solitary HCC patients treated with SBRT. Patients and methods: Patients with HBV-associated small solitary HCC who were newly treated with SBRT were retrospectively analysed in our hospital from 2009 to 2016. We counted the APRI, NLR, PLR, and LMR before treatment and calculated their cut-off values for predicting overall survival (OS) and progression-free survival (PFS) by receiver operating characteristic (ROC) analysis. The random forest model combined with least absolute shrinkage and selection operator (LASSO) regression model for OS and PFS were used to screen potentially prognostic factors from serum inflammatory markers, demographic data, and clinical characteristics. Predictive models for OS and PFS were developed by multivariable COX regression and nomograms were constructed. Discrimination was assessed using the C-index. Internal validation was assessed using the Bootstrap method. Survival analysis was carried out to assess the prognostic value of serum inflammatory markers, and OS and PFS curves were compared by Kaplan-Meier analysis and Log-Rank test, respectively. Results: A total of 72 patients with HBV-associated small solitary HCC were recruited for the study. The median follow-up time was 2015 days (range, 232-3823 days). Age, tumor size, NLR, PLR, and APRI were used to construct nomogram for OS, while gender, age, TNM stage, portal hypertension, AFP, APRI were for PFS. The two models displayed good discriminations with C-indexes of 0.738 (95% CI: 0.632-0.844) and 0.657 (95% CI: 0.538-0.777), and their C-indexes in the internal validation cohort reached 0.790 (95% CI: 0.684-0.896) and 0.739 (95% CI: 0.619-0.859). The multivariable cox analysis indicated that APRI<0.47 was favourable independent prognostic factors for OS and PFS. Compared to APRI≥0.47, APRI<0.47 predicts better OS (p=0.003) and PFS (p=0.003). Conclusions: Nomograms based on APRI are superior in predicting OS and PFS in HBV-associated small solitary HCC patients who have received SBRT. APRI before treatment is a feasible and convenient prognostic indicator for OS and PFS, which helpfully determines the beneficial population of SBRT for HBV-associated small solitary HCC.

Keywords: aspartate aminotransferase-to-platelet index; hepatocellular carcinoma; stereotactic body radiotherapy.

© The author(s).

StephenW

基于APRI的新型预测性线形图在立体定向身体放疗治疗乙型肝炎病毒相关的小型孤立性肝细胞癌中的应用
林来1 2，苏婷诗1，中果梁1，陆云兴2，后村村2，祖平联2，洪洪军3，朱晓东4 1
隶属关系
隶属关系

    1个
    广西医科大学附属肿瘤医院放疗科，广西南宁530021
    2
    广西中医药大学附属瑞康医院肿瘤内科，广西南宁530011
    3
    广西中医药大学附属瑞康医院泌尿外科，中国广西南宁530011
    4
    广西医科大学附属武鸣医院肿瘤科，广西南宁530199

    PMID：33046985 PMCID：PMC7545675 DOI：10.7150 / jca.47291

抽象

背景：立体定向放射疗法（SBRT）治疗后血清炎症标志物与乙型肝炎病毒（HBV）相关的小孤立性肝细胞癌（HCC）患者生存之间的相关性尚不清楚。我们研究的目的是使用多变量预测模型评估此类患者的生存率，并研究天冬氨酸转氨酶与血小板指数（APRI），中性粒细胞与淋巴细胞比（NLR），血小板与淋巴细胞比（ PLR），以及SBRT治疗的与HBV相关的孤立性小肝癌患者的淋巴细胞与单核细胞比率（LMR）。患者和方法：回顾性分析我院2009年至2016年新接受SBRT治疗的HBV相关性小孤立性肝癌的患者。我们对治疗前的APRI，NLR，PLR和LMR进行了计数，并计算了其临界值。通过接收者操作特征（ROC）分析预测总体生存期（OS）和无进展生存期（PFS）。用于OS和PFS的随机森林模型与最小绝对收缩和选择算子（LASSO）回归模型相结合，用于从血清炎症标志物，人口统计学数据和临床特征中筛选潜在的预后因素。通过多变量COX回归开发了OS和PFS的预测模型，并构建了列线图。使用C指数评估歧视。使用Bootstrap方法评估内部验证。进行生存分析以评估血清炎症标志物的预后价值，并分别通过Kaplan-Meier分析和Log-Rank检验比较OS和PFS曲线。结果：共招募了72例HBV相关性小孤立性HCC患者。中位随访时间为2015天（范围232-3823天）。年龄，肿瘤大小，NLR，PLR和APRI用于构建OS的诺模图，而性别，年龄，TNM分期，门脉高压，AFP，APRI用于PFS。这两个模型显示出良好的辨别力，其C指数分别为0.738（95％CI：0.632-0.844）和0.657（95％CI：0.538-0.777），内部验证队列中的C指数达到0.790（95％CI： 0.684-0.896）和0.739（95％CI：0.619-0.859）。多变量cox分析表明，APRI <0.47是OS和PFS的有利独立预后因素。与APRI≥0.47相比，APRI <0.47预测更好的OS（p = 0.003）和PFS（p = 0.003）。结论：基于APRI的Nomogram在预测已接受SBRT的HBV相关的小型孤立HCC患者的OS和PFS方面具有优势。治疗前APRI是OS和PFS的一种可行且方便的预后指标，有助于确定HBRT相关的小型孤立HCC SBRT的有益人群。

关键词：天冬氨酸转氨酶-血小板指数；肝细胞癌；立体定向身体放疗。

©作者。

StephenW

https://www.jcancer.org/v11p6642.pdf