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Construction and validation of a nomogram for hepatocellular carcinoma patients treated by traditional Chinese medicine based on inflammation, nutrition, and blood lipid indicators

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Abstract

Purpose

To establish a nomogram for hepatocellular carcinoma (HCC) patients treated by traditional Chinese medicine (TCM).

Methods

Clinical cases of HCC patients treated by TCM at Hunan Integrated Traditional Chinese and Western Medicine Hospital, and it was randomly divided into the training cohort (n = 222) and the validation cohort (n = 95). In the training cohort, independent risk factors were determined by Cox regression analysis and a nomogram was constructed. The efficiency and clinical applicability of nomograms were evaluated using time-dependent curves, calibration, and the decision curve (DCA), and the patients were divided into high-risk, middle-risk and low-risk groups using X-tile software.

Results

Multivariate Cox regression analysis screened 6 independent risk factors to construct a nomogram of HCC patients, including TNM stage, treatment methods, high-density lipoprotein (HDL), neutrophil-to-lymphocyte ratio (NLR), albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI). The consistency index (C-index) of the nomogram of the training was 0.811 (0.794–0.829) and the validation cohort was 0.825 (0.800–0.849). The time dependency showed the AUC values of the nomogram for 3 and 5 years in training cohort were 0.894 (95% CI 0.840–0.948) and 0.952 (95% CI 0.914–0.990), and the validation cohort were 0.928 (95% CI 0.865–0.990) and 0.96 3(95% CI 0.916–1.010). The calibration plot showed the nomogram fits well onto perfect curves, and the DCA curve showed the net benefit of the nomogram at a certain probability threshold is significantly higher than the net benefit of the TNM stage at the same threshold probability. Finally, all the patients were divided into high-risk, middle-risk and low-risk groups based on the total score of nomogram, and it showed effectively how to identify to high-risk patients.

Conclusion

The nomogram established by the independent risk factors of TNM stage, treatment methods, HDL, AGR, NLR and PNI can predict the prognosis of HCC patients treated by TCM, providing an effective tool to clinical workers to evaluate the prognosis and survival time of HCC patients.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

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Funding

This work was supported by National Natural Science Foundation of China (82074425, 82205227); Natural Foundation of Hunan Provincial (2021JJ30417); Young Qihuang Scholars Talent Project of National Administration of Traditional Chinese Medicine; Hunan Provincial Health Commission Traditional Chinese Medicine Shennong Leading Talent Project; Hunan Province Science and Technology Top Leading Talent Project.

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Author notes

  1. Xiaopeng Yu and Renyi Yang contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Hunan University of Chinese Medicine, Changsha, 410208, Hunan, China

    Xiaopeng Yu & Renyi Yang

  2. Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410006, Hunan, China

    Zuomei He & Puhua Zeng

  3. Cancer Research Institute of Hunan Academy of Traditional Chinese Medicine, Changsha, 410006, Hunan, China

    Zuomei He & Puhua Zeng

Authors
  1. Xiaopeng Yu
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  2. Renyi Yang
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  3. Zuomei He
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  4. Puhua Zeng
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Contributions

All the authors have had access to the data and all drafts of the manuscript. Specific contributions are as follows: data collection, data management, data analysis, and manuscript drafting: XY. Study design: XY and RY. Manuscript review: all. Funding sources: PZ and ZH.

Corresponding authors

Correspondence to Zuomei He or Puhua Zeng.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

Our Institutional Review Board (Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine) approved this study and waived the need for informed consent from patients.

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Yu, X., Yang, R., He, Z. et al. Construction and validation of a nomogram for hepatocellular carcinoma patients treated by traditional Chinese medicine based on inflammation, nutrition, and blood lipid indicators. J Cancer Res Clin Oncol 149, 8969–8979 (2023). https://doi.org/10.1007/s00432-023-04830-y

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  • DOI: https://doi.org/10.1007/s00432-023-04830-y

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