Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma.,Cancer Medicine

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Nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma.
Cancer Medicine ( IF 2.9 ) Pub Date : 2020-01-05 , DOI: 10.1002/cam4.2823
Lang Chen ₁ , Furong Zeng ₁ , Lei Yao ₁ , Tongdi Fang ₁ , Mengting Liao ₁ , Jing Long ₁ , Liang Xiao ₁ , Guangtong Deng ₁

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OBJECTIVE To establish nomogram based on inflammatory indices for differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). METHODS A cohort of 422 patients with HCC or ICC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent differential factors. Through combining these independent differential factors, a nomogram was established for differential diagnosis between ICC and HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The results were validated using a prospective study on 98 consecutive patients operated on from January 2019 to November 2019 at the same institution. RESULTS Sex (OR = 9.001, 95% CI: 3.268-24.792, P < .001), hepatitis (OR = 0.323, 95% CI: 0.121-0.860, P = .024), alpha-fetoprotein (AFP) (OR = 0.997, 95% CI: 0.995-1.000, P = .046), carbohydrate antigen 19-9 (CA199) (OR = 1.016, 95% CI: 1.007-1.025, P < .001), and aspartate transaminase-to-neutrophil ratio index (ANRI) (OR = 0.904, 95% CI: 0.843-0.969, P = .004) were the independent differential factors for ICC. Nomogram was established with well-fitted calibration curves through incorporating these 5 factors. Comparing model 1 including gender, hepatitis, AFP, and CA199 (C index = 0.903, 95% CI: 0.849-0.957) and model 2 enrolling AFP and CA199 (C index = 0.850, 95% CI: 0.791-0.908), the nomogram showed a better discrimination between ICC and HCC, with a C index of 0.920 (95% CI, 0.872-0.968). The results were consistent in the validation cohort. DCA also confirmed the conclusion. CONCLUSION A nomogram was established for the differential diagnosis between ICC and HCC preoperatively, and better therapeutic choice would be made if it was applied in clinical practice.

中文翻译：

基于炎症指数的诺法图可用于区分肝内胆管癌和肝细胞癌。

目的建立基于炎症指数的诺模图，以区分肝内胆管癌（ICC）和肝细胞癌（HCC）。方法纳入2014年1月至2018年12月在湘雅医院住院的422例HCC或ICC患者。进行单变量和多变量分析以识别独立的差异因素。通过组合这些独立的微分因子，建立了用于诊断ICC和HCC的诺模图。通过使用接收器工作特性（ROC）曲线，校准曲线和决策曲线分析（DCA）来评估列线图的准确性。使用前瞻性研究对从2019年1月至2019年11月在同一机构接受手术的98例连续患者进行了前瞻性研究验证。结果性别（OR = 9.001，95％CI：3.268-24.792，P <.001），肝炎（OR = 0.323，95％CI：0.121-0.860，P = .024），α-甲胎蛋白（AFP）（OR = 0.997，95％CI：0.995-1.000，P = .046），碳水化合物抗原19-9（CA199）（OR = 1.016，95％CI：1.007-1.025，P <.001），和天冬氨酸转氨酶转化为中性粒细胞比率指数（ANRI）（OR = 0.904，95％CI：0.843-0.969，P = .004）是ICC的独立微分因子。通过结合这5个因素，利用拟合得很好的校准曲线建立了线型图。比较包括性别，肝炎，AFP和CA199的模型1（C指数= 0.903，95％CI：0.849-0.957）和模型2注册AFP和CA199（C指数= 0.850，95％CI：0.791-0.908），列线图在ICC和HCC之间显示出更好的区分度，C指数为0.920（95％CI，0.872-0.968）。结果在验证队列中是一致的。DCA也证实了这一结论。结论建立了术前ICC和HCC鉴别诊断的诺模图，如果将其用于临床，将有更好的治疗选择。

更新日期：2020-01-06

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