摘要
Abstract
Objective:To construct and validate a Nomogram prediction model for the prognosis of targeted-immunotherapy in patients with advanced liver cancer,so as to provide a reliable basis for the formulation of individualized treatment decisions in clinical practice.Methods:A total of 150 patients with advanced liver cancer who received targeted-immunotherapy combined therapy and were admitted to the department of oncology,Ji'an Central People's Hospital,Jiangxi province from May 2022 to January 2025 were selected as the research objects.Prognostic factors were preliminarily screened through univariate analysis,and independent predicators were further determined by Logistic regression analysis,and a visual Nomogram prediction model was constructed.The model performance was systematically evaluated by using methods such as receiver operating characteristic(ROC)curve,calibration curve,Bootstrap internal validation(1 000 repeated samples),and decision curve analysis(DCA).Results:The incidence of poor prognosis within 6 months after targeted-immunotherapy in patients with advanced liver cancer was 20.67％(31/150).Barcelona Clinic Liver Cancer(BCLC)C[OR=4.171,95％CI(1.918,9.072)],portal vein invasion[OR=3.337,95％CI(1.609,6.923)],neutrophil-to-lymphocyte ratio(NLR)≥3[OR=4.889,95％CI(2.059,11.607)],alpha-fetoprotein(AFP)≥400 ng/mL[OR=3.228,95％CI(1.517,6.869)],albumin(ALB)＜35 g/L[OR=2.835,95％CI(1.343,5.984)]and treatment interruption[OR=4.463,95％CI(1.895,10.509)]were independent risk factors(P＜0.05).The model validation results showed that the discrimination was good,and the area under the curve(AUC)was 0.823[95％CI(0.774,0.872)].Good calibration(Hosmer-Lemeshow test x2=6.854,P=0.335,mean absolute deviation=0.025).Internal validation adjusted C-statistic 0.812[95％CI(0.758,0.866)].Decision curve analysis showed that there was a significant clinical net benefit within the threshold probability range of 20％to 80％,with the highest reaching 41.25％.Conclusions:The Nomogram prediction model for the prognosis of targeted-immunotherapy in patients with advanced liver cancer integrates clinical features,laboratory indicators and therapeutic factors.It has good discriminative ability,calibration accuracy and clinical practicability,and can provide objective and quantitative decision support for the prognosis assessment and individualized intervention of targeted-immunotherapy in patients with advanced liver cancer.关键词
肝细胞癌/靶向治疗/免疫治疗/预后预测/列线图Key words
hepatocellular carcinoma/targeted therapy/immunotherapy/prognostic prediction/Nomogram
