基于贝叶斯网络的肝内胆管癌根治术后生存预测模型的初步探讨

Objective To examine a survival prognostic model applicable for patients with intrahepatic cholangiocarcinoma (ICC) based on Bayesian network. Methods The clinical and pathological data of ICC patients who underwent curative intent resection in ten Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected.A total of 516 patients were included in the study. There were 266 males and 250 females.The median age (M(Q_R)) was 58(14) years.One hundred and sixteen cases (22.5%) with intrahepatic bile duct stones, and 143 cases (27.7%) with chronic viral hepatitis.The Kaplan‐Meier method was used for survival analysis.The univariate and multivariate analysis were implemented respectively using the Log‐rank test and Cox proportional hazard model. One‐year survival prediction models based on tree augmented naive Bayesian (TAN) and naïve Bayesian algorithm were established by Bayesialab software according to different variables, a nomogram model was also developed based on the independent predictors.The receiver operating characteristic curve and the area under curve (AUC) were used to evaluate the prediction effect of the models. Results The overall median survival time was 25.0 months,and the 1‐,3‐and 5‐year cumulative survival rates was 76.6%,37.9%,and 21.0%, respectively. Univariate analysis showed that gender, preoperative jaundice, pathological differentiation,vascular invasion,microvascular invasion,liver capsule invasion,T staging,N staging, margin,intrahepatic bile duct stones,carcinoembryonic antigen,and CA19‐9 affected the prognosis (χ²=5.858-54.974, all P<0.05). The Cox multivariate model showed that gender, pathological differentiation,liver capsule invasion, T stage,N stage,intrahepatic bile duct stones,and CA19‐9 were the independent predictive factors(all P<0.05). The AUC of the TAN model based on all 19 clinicopathological factors was 74.5%,and the AUC of the TAN model based on the 12 prognostic factors derived from univariate analysis was 74.0%,the AUC of the naïve Bayesian model based on 7 independent prognostic risk factors was 79.5%,the AUC and C‐index of the nomogram survival prediction model based on 7 independent prognostic risk factors were 78.8% and 0.73,respectively. Conclusion The Bayesian network model may provide a relatively accurate prognostic prediction for ICC patients after curative intent resection and performed superior to the nomogram model.