预后模型中的竞争风险偏差预测肝细胞癌发生:对临床决策的影响
Hamish Innes1,2,3, Philip Johnson4, Scott A McDonald1,2
1School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Gastro hep advances
|August 12, 2024
概括
现有的肝细胞癌 (HCC) 模型通过忽略竞争事件来高估风险. 虽然发生过高估计,但其对治疗型肝炎的肝硬化患者的HCC查决策的影响可能很小.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 医学统计 医学统计
- 流行病学 流行病学
背景情况:
- 肝细胞癌 (HCC) 在肝硬化和已治愈的型肝炎患者中是一个重大问题.
- 现有的HCC预后模型往往无法考虑竞争的风险,例如非HCC死亡率.
- 这种遗漏可能导致HCC概率的高估.
研究的目的:
- 量化HCC风险预测中因忽视竞争事件而导致的偏差.
- 为了比较HCC概率估计从模型与或没有竞争风险调整在特定的患者队列.
主要方法:
- 分析了来自苏格兰的1629名肝硬化和治愈的型肝炎患者的全国队列.
- 开发了两个预测模型:考克斯回归模型 (忽略竞争风险) 和细灰回归模型 (对竞争风险进行核算).
- 对每个患者的两个模型之间的3年HCC概率预测的比较.
主要成果:
- 在平均3.8年的随访期间,共观察到82例HCC事件和159例非HCC死亡.
- 与细灰模型 (3.24%) 相比,Cox模型 (3.37%) 的平均预测3年HCC概率略高一些.
- 在76%的患者中观察到极小的差异 (<0.3%);然而,在2.6%的患者中,最初高HCC风险预测的差异>2%.
结论:
- 忽视竞争风险的预测模型往往会高估发展HCC的可能性.
- 这种过高估计的规模和模式表明,它可能对临床决策产生适度的影响,这可能是对该人群中HCC查的临床决定的影响.
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