摘要
目的当前晚期肝癌的预后评估缺乏中医证候要素,尤其忽视“虚证”对生存质量及治疗耐受性的影响。本研究旨在整合中西医预后预测因子,构建一个简便的晚期肝癌预后预测模型,并为虚证评估提供标准,以指导个体化临床决策。方法纳入122例晚期肝癌患者进行回顾性队列分析,探讨脾虚程度与预后的关系。采用单因素及多因素Cox回归分析建立中西医整合的晚期肝癌预后模型,并通过受试者工作特征曲线(receiver operating characteristic,ROC)、校准曲线和决策曲线分析(decision curve analysis,DCA)评估模型性能。结果脾虚程度与晚期肝癌不良预后显著相关。Cox多因素分析确定Child-Pugh分级、脾虚分级、前白蛋白和一般健康状态(performance status,PS)评分是总生存期(overall survival,OS)的独立预测因素。基于上述变量构建的预后模型在6个月/12个月/24个月的ROC曲线下面积(area under the ROC curve,AUC)值分别为0.847、0.937和0.967,校准曲线贴合理想对角线,DCA显示具有临床净收益,性能优于单一Child-Pugh分级或PS评分。经过1000次Bootstrap抽样进行内部验证后,模型收缩系数:1.136,表明该模型有较好的稳定性。结论脾虚是晚期肝癌预后的重要影响因素。本研究构建的中西医整合列线图能准确预测患者6个月/12个月/24个月生存率,所建立的虚证评价标准可为中西医联合治疗中“扶正”与“祛邪”的策略选择提供依据。
Objective Current prognostic assessments for advanced liver cancer lack elements of traditional Chinese medicine(TCM)syndromes,particularly overlooking the impact of“deficiency patterns”on quality of life and treatment tolerance.This study aims to integrate prognostic predictors of both Western medicine and TCM to construct a simple prognostic prediction model for advanced liver cancer and to establish standards for deficiency pattern assessment,thereby guiding individualized clinical decision-making.Methods A retrospective cohort analysis was conducted on 122 patients with advanced liver cancer to explore the relationship between the degree of spleen deficiency and prognosis.Univariate and multivariate Cox regression analyses were used to develop an integrated Western medicine and TCM prognostic model for advanced liver cancer.The model’s performance was evaluated using receiver operating characteristic(ROC),calibration curves,and decision curve analysis(DCA).Results The degree of spleen deficiency was significantly associated with poor prognosis in advanced liver cancer.Multivariate Cox analysis identified Child-Pugh grade,spleen deficiency grade,prealbumin level,and performance status(PS)score as independent predictors of overall survival(OS).The prognostic model constructed based on these variables achieved the area under the ROC curve(AUC)of 0.847,0.937,and 0.967 for 6-month,12-month,and 24-month survival,respectively.The calibration curves closely aligned with the ideal diagonal,and DCA demonstrated clinical net benefit,with performance superior to that of the Child-Pugh grade or PS score alone.After 1000 Bootstrap samplings for internal validation,the model shrinkage coefficient was 1.136,indicating that the model had good stability.Conclusion Spleen deficiency is an important factor influencing the prognosis of advanced liver cancer.The integrated Western medicine and TCM nomogram developed in this study accurately predicts patients’survival rates at 6,12,and 24 months.The established deficiency pattern evaluation criteria can provide a basis for selecting strategies of“reinforcing healthy qi”and“eliminating pathogens”in combined Western medicine and TCM treatment.
作者
黄佳兴
罗慧燕
张晓莹
蔡玉荣
潘华峰
王雄文
HUANG Jiaxing;LUO Huiyan;ZHANG Xiaoying;CAI Yurong;PAN Huafeng;WANG Xiongwen(The First Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Department of Oncology,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Department of Oncology,Shenzhen Hospital(Futian)of Guangzhou University of Chinese Medicine,Shenzhen 518000 Guangdong,China;Department of Oncology,Chongqing Beibei Traditional Chinese Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine/Chongqing Beibei District Hospital of Traditional Chinese Medicine,Chongqing 400700,China;Science and Technology Innovation Center,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China)
出处
《中医肿瘤学杂志》
2025年第6期28-40,共13页
Journal of Oncology in Chinese Medicine
基金
重庆市科卫联合中医药科研项目重大项目(编号:2024ZYDB001)
国家自然科学基金面上项目(编号:82274605)
国家自然科学基金面上项目(编号:82474591)
深圳市基础研究专项自然科学基金面上项目(编号:JCYJ20240813160605008)。
关键词
原发性肝癌
中医
脾虚
列线图
预后模型
primary liver cancer
traditional Chinese medicine
spleen deficiency
nomogram
prognostic model
