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目的:建立一个有效的列线图预测乙型肝炎(乙肝)相关肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)病人的术后生存。方法:回顾性分析我院2003年1月至2009年12月期间415例乙肝相关ICC手术病人临床数据(模型组),通过COX回归模型的结果建立预测病人术后生存的列线图。用2010年在我院行手术治疗的126例乙肝相关ICC病人的临床资料(验证组)来验证列线图的预测效果。生存曲线比较TNM分期与列线图对病人的预测。通过一致性指数(C-index)比较TNM分期与列线图对病人生存预测的准确性。结果:列线图共包含6个预测指标。模型组的列线图预测术后生存的C-index值0.72(95%CI:0.70~0.73),验证组C-index值0.73(95%CI:0.71~0.76),证实列线图对生存的预测准确度高。列线图预测包括模型组和验证组541例病人术后生存的C-index值是0.71(95%CI:0.68~0.74),高于美国癌症联合会第7版TNM分期的0.63(95%CI:0.60~0.66)。结论:基于HBV-DNA载量、CA19-9、肝硬化、术中输血、肿瘤直径以及淋巴结转移构建预测的列线图可提高乙肝相关ICC病人术后生存的预测准确度。
Objective: To establish an effective nomogram to predict postoperative survival in patients with intrahepatic cholangiocarcinoma (ICC). Methods: A retrospective analysis of clinical data (model group) of 415 patients with hepatitis C-related ICC surgery from January 2003 to December 2009 in our hospital was performed. The COX regression model was used to establish the nomogram for predicting postoperative survival. The prediction of the nomogram was validated using clinical data from 126 patients with ICC who underwent surgical treatment in our hospital in 2010 (validation group). Survival curves comparing patients with TNM staging and nomogram prediction. The accuracy of TNM staging and nomogram in predicting patient survival was compared by C-index. Results: The nomogram contains a total of six predictors. The C-index of the model group was 0.72 (95% CI: 0.70-0.73) and 0.73 (95% CI: 0.71-0.76) in the validation group, confirming the survival of the nomogram High prediction accuracy. The C-index values for postoperative survival in 541 patients including model group and validation group were 0.71 (95% CI: 0.68-0.74), higher than the 0.63 (95% CI) for the 7th TNM stage of the American Cancer Society : 0.60 ~ 0.66). CONCLUSION: The proposed nomogram based on HBV-DNA load, CA19-9, cirrhosis, intraoperative blood transfusion, tumor diameter and lymph node metastasis can improve the predictive accuracy of postoperative survival in patients with hepatitis B associated ICC.