以肿瘤总体积为基础的新型肝癌肝切除术前复发预测模型的建立  

A prognostic model based on the total tumor volume predicted tumor recurrence of hepatoceilular carcino-ma following liver resection

作　　者：阮丹云[1] 李洋[2,3,4] 林泽晓[1] 吴东昊[1] 汪国营[2,3,4] 冯啸[2,3,4] 张剑[2,3,4] 李华[2,3,4] 吴祥元[1] 姜楠[2,3,4] 

机构地区：[1]中山大学附属第三医院肿瘤内科,广州510630 [2]中山大学附属第三医院肝脏外科暨肝脏移植中心究 [3]中山大学器官移植研究所 [4]广东省器官移植研中心

出　　处：《中华肝胆外科杂志》2013年第11期808-814,共7页Chinese Journal of Hepatobiliary Surgery

基　　金：国家重点基础研究发展计划（2009CB522404）;国家十二五科技重大专项（2012ZX10002017-005）;国家自然基金（81000959）;广东省科技计划项目（20098030801007）;中央高校基本业务费青年教师培育项目（12ykpy47,12ykpy43）;广东省教育部产学研结合项目（20128091100460）

摘　　要：目的分析肝癌术前复发高危因素，建立一个基于肿瘤总体积（TTV）的新型肝癌术前复发预测模型。方法回顾性分析2003—2010年于我院接受肝切除术的196例原发性肝癌患者资料，应用单因素及COX风险模型分析临床因素与术后复发的关系，建立预后指数模型。通过计算受试者操作特征（ROC）曲线下面积（AUC）、Akaike信息标准（AIC）以及似然比卡方值，评价新模型与目前所用4种分期（TNM分期、OKUDA分期、CLIP评分系统、BCLC分期）系统的优劣。结果将TTV〉115cm。、乙肝表面抗原（HBsAg）阳性、Child-Turcotte—Pugh（CTP）分级B级和门静脉癌栓（PVTT）四个影响肿瘤复发的术前指标分别赋值1分建立预测复发评分模型。根据得分情况将患者分为A（0～1分）、B（2分）、C（3分）、D（4分）四个等级，其1年无瘤复发生存率分别为：80．1％、47．8％、28．6％、0％，3年无瘤复发生存率分别为62．4％、34．8％、0％、0％，各组之间无瘤复发生存率具有显著差异（P〈O．01）。预测复发评分新模型3年无复发生存ROC曲线下面积（AUC）为0．643，TNM为0．599，OKUDA为0．495，CLIP为0．562，BCLC为0．591；新模型AIc值为252．142，TNM为268．956，OKUDA为274．751，CLIP为269．844，BCLC为268．998。结论TTV作为一种描述肿瘤负荷的新指标，与肝癌切除术后复发以及患者总预后相关。基于TTV、HBsAg、CTP分级和PVTT4个指标建立的新模型能够较准确地预测原发性肝癌患者肝切除术后复发风险。Objective To determine the risk factors and to set up a prognostic model to predict early recurrence of hepatocellular carcinoma （HCC） after liver resection. Methods From 2003 to 2010, 196 HCC patients who underwent liver resection were retrospectively studied. Univariate and multivariate analyses were used to assess the variables. A recurrence risk model was developed with independent prognostic factors. The predictive value was evaluated using receiver operator characteris- tic curve （ROC） analyses, and the results were compared to those obtained using the commonly used methods. Results The median follow-up was 33 months （1-103 mouths）, and the median recurrence- free survival was 22 months. The total tumor volume （TTV）, HBsAg status, Child-Pugh score and portal vein tumor thrombus were independent factors of recurrence. A risk model was then established consisting of the 4 parameters, and the patients were classified into 4 stages. There were significant differences between each of these stages. The 3-year recurrence-free survival （RFS） rates were： 62.4% vs 34.8% vs 0% vs 0% （P^0.01）, and the 1-year RFS rates were： 80.1% vs 47.8% vs28.6% vs 0M （P〈0.01）. When compared with the 4 currently used staging systems （BCLC, TNM, CLIP and Okuda）, the TTV based model better predicted the patient＇s survival, with the largest AUC and smallest AIC for both RFS and OS, especially for early recurrence. Conclusions This prog nostic model predicted tumor recurrence and survival of patients who received radical liver resection. It contributes to select patients who may benefit from surgery.

关 键 词：原发性肝癌 肝切除术 肿瘤总体积 复发风险模型 

分 类 号：R735.7[医药卫生—肿瘤]