Study on prognostic risk factors of patients with primary liver cancer based on SEER database

Abstract:

Objective To explore the prognostic risk factors of patients with primary liver cancer， so as to provide a scientific basis for the clinical diagnosis，treatment and prognosis of the patients with this disease.Methods The patients with primary liver cancer from the 2018 Surveillance，Epidemiology and End Results（SEER） database were served as the research subjects， the demographic data， clinical indicators and prognostic follow-up information were collected，and the risk factors affecting postoperative survival were analyzed by using the univariate and multivariate logistic regression. The consistency index was used to evaluate the prediction ability of the model，and the performance of the prediction model was analyzed by constructing the receiver operating characteristic（ROC） curve. The forest map was used to analyze the treatment methods of liver cancer patients at different stages.Results A total of 1 750 patients with primary liver cancer in 2018 were collected in the study. The univariate logistic regression results showed that the tumor staging，lymph node metastasis，distant metastasis，marital status，radiochemotherapy and surgery were the risk factors affecting the survival of the patients with primary liver cancer（P<0.05）；the multivariate Logistic regression analysis results showed that the tumor staging [T2/T3 relative to T1，OR=5.142/3.390，95%CI=（3.654-7.236）/（2.327-4.939），P<0.001]，distant metastasis（OR=4.810， 95%CI=3.384-6.839，P<0.001），marital status（0.729，95%CI=0.575-0.925，P=0.009），radiotherapy（OR=0.361，95%CI=0.260-0.503，P<0.001），chemotherapy（OR=0.512，95%CI=0.381-0.687，P=0.001） and surgery（OR=0.245，95%CI=0.105-0.574，P=0.028） were the risk factors affecting the survival of the patients with liver cancer. The significant variables in logistic regression were used to conduct the construction of the prediction model. The study showed that the concordance index of the model was 0.786 （95%CI=0.762-0.810），and the area under the curve（AUC） of the model was 0.790（95%CI=0.764-0.812）. The interventional means of radiotherapy alone showed an advantage in the patients with any tumor staging（P=0.003，P=0.013，P=0.003）. In the patients without lymph node metastasis，no matter which intervention means would reduce the mortality of the patients with liver cancer（P<0.001，P=0.001，P<0.001，P=0.004），but in the patients with lymph node metastasis， whether conducting intervention had no effect on the survival of the patients with liver cancer（P>0.05）. Among the patients without distant metastasis，the survival rate of the patients with only radiotherapy，only chemotherapy and chemotherapy + radiotherapy intervention was higher than that of the patients without intervention（P<0.001，P=0.001，P<0.001，P=0.004）. Among the patients with distant metastasis，only the interventional means of radiotherapy showed the advantage（P=0.002）.Conclusion The tumor staging，distant metastasis，marital status， radiochemotherapy and surgery are the risk factors affecting the prognosis of primary liver cancer.