Construction and clinical significance of a prognostic prediction model for patients with spinal metastasis after hepatocellular carcinoma resection

English Keywords:Spinal metastasis  Hepatocellular carcinoma  Prediction model

English Abstract:

  【Abstract】 Objectives: To explore the factors influencing the prognosis of patients with spinal metastasis after hepatocellular carcinoma surgery and construct a nomogram prediction model. Methods: A retrospective analysis was conducted on the clinical data of 50 patients with spinal metastasis after hepatocellular carcinoma surgery admitted to Zhongshan Hospital, Fudan University, from April 2011 to October 2020. There were 39 males and 11 females. Baseline data were collected, including patient age, general condition[Karnofsky performance scale(KPS)], laboratory indicators(albumin, hemoglobin, white blood cell count, liver function indicators, and high-sensitivity C-reactive protein), spinal neurological impairment(Frankel grade), tumor marker levels(alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 199), distribution and number of bone metastases, presence of visceral metastases, spinal stability[spinal instability neoplastic score(SINS)], degree of dural and spinal cord compression[epidural spinal cord compression(ESCC) score], modified Tokuhashi score, Tomita score, New England Spinal Metastasis Score, and treatment condition for spinal metastasis. Survival analysis was performed based on clinical characteristics and prognosis. Univariate and multivariate Cox regression analyses were used to screen prognostic factors in patients with spinal metastasis after hepatocellular carcinoma surgery. Based on the analysis results of influencing factors, a nomogram prediction model was constructed and internally validated using the Bootstrap method. The nomogram prediction model was compared with the prediction models of spinal metastasis-related scoring systems to validate its prognostic prediction value for patients with spinal metastasis after hepatocellular carcinoma surgery. Results: The age of the 50 patients ranged from 32 to 85 years(54.3±10.9 years), with a median survival time of 33 months(95%CI: 27-39 months). Univariate and multivariate Cox regression analyses showed that surgical treatment of spinal metastasis, high-sensitivity C-reactive protein, and hemoglobin were independent predictors of prognosis in patients with spinal metastasis after hepatocellular carcinoma surgery(P<0.05). The nomogram prediction model, constructed based on the analysis results of influencing factors and validated internally using the Bootstrap method, showed that its calibration curve was close to the standard curve, with a concordance index of 0.697. Receiver operating characteristic(ROC) curves were plotted, and the results showed that the area under the curve(AUC) of the nomogram prediction model for predicting the expected survival rates at 12, 24, and 36 months in patients with spinal metastasis after hepatocellular carcinoma surgery was 0.771(95%CI: 0.585-0.958, P<0.001), 0.796(95%CI: 0.679-0.913, P<0.001), and 0.810(95%CI: 0.695-0.924, P<0.001), respectively. Decision curve analysis indicated that the model demonstrated the best clinical prediction performance for the 12-month, 24-month, and 36-month prognosis of patients with spinal metastasis after hepatocellular carcinoma surgery when the risk thresholds were(0.0-0.12, 0.02-0.61), (0.0-0.25, 0.06-0.64), and(0.0-0.5, 0.20-0.83), respectively. Conclusions: Spine metastasis surgery, high-sensitivity C-reactive protein levels, and hemoglobin levels are independent prognostic factors for patients with hepatocellular carcinoma who develop spinal metastases after surgery. The nomogram prediction model constructed based on these factors demonstrates strong predictive capability for the prognosis of such patients, therefore is conducive to clinical decision-making and early intervention.