首诊乙型肝炎病毒相关肝细胞癌发生门静脉癌栓和肝外转移的危险因素及预测列线图  

Risk factors and predictive nomograms of portal vein tumor thrombus and extrahepatic metastasis in the first diagnosed hepatitis B viral-related hepatocellular carcinoma

作　　者：林彤 何力[2] 彭立生[3] LIN Tong;HE Li;PENG Lisheng(the Fourth Clinical Medical School,Guangzhou University of Chinese Medicine,Shenzhen 518033,Guangdong,China;Department of Oncology and Haematology,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China;Department of Science and Education,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033,Guangdong,China)

机构地区：[1]广州中医药大学第四临床医学院,广东深圳518033 [2]深圳市中医院肿瘤与血液病科,广东深圳5180330 [3]深圳市中医院科教科,广东深圳5180330

出　　处：《癌症进展》2021年第15期1546-1552,共7页Oncology Progress

基　　金：广东省医学科研基金(A2021291)。

摘　　要：目的分析首诊乙型肝炎病毒相关肝细胞癌(HBV-HCC)患者发生门静脉癌栓(PVTT)和肝外转移(EHM)的独立危险因素,构建并评价风险预测列线图。方法选取200例首诊HBV-HCC患者,采用单因素和多因素Logistic回归分析其发生PVTT和EHM的独立危险因素。用R软件构建风险评分列线图,绘制受试者工作特征(ROC)曲线、校准曲线及决策曲线评估列线图的预测效果及临床效用。结果200例首诊HBV-HCC的患者中,77例发生PVTT,31例发生EHM,21例同时存在PVTT和EHM。多因素Logistic回归分析结果显示,肿瘤大体病理分型为块状型或弥漫型、多发肿瘤、总胆红素水平≥17.1μmol/L、血小板与淋巴细胞比值(PLR)≥128.8均为首诊HBV-HCC患者发生PVTT的独立危险因素(P﹤0.05);肿瘤大体病理分型为块状型或弥漫型、多发肿瘤、中性粒细胞计数≥6.3×10^(9)/L均是首诊HBV-HCC患者发生EHM的独立危险因素(P﹤0.05)。PVTT和EHM预测列线图的ROC曲线下面积分别为0.857和0.862,有良好的预测能力和临床效益。结论本研究构建的列线图用于首诊HBV-HCC患者发生PVTT和EHM的个体化预测价值较好,具有临床应用前景。Objective Analyze the independent risk factors of portal vein tumor thrombus(PVTT)and extrahepatic metastasis(EHM)in patients with first-diagnosed hepatitis B virus-related hepatocellular carcinoma(HBV-HCC),and construct and evaluate the risk prediction nomogram.Method A total of 200 first-diagnosed HBV-HCC patients were se-lected,and single factor and multivariate Logistic regression were used to analyze the independent risk factors for PVTT and EHM.Use R software to construct a risk score nomogram,draw receiver operating characteristic(ROC)curve,cali-bration curve and decision curve to evaluate the predictive effect and clinical utility of the nomogram.Result There were 77 cases of PVTT,31 cases of EHM and 21 cases of PVTT+EHM in 200 cases of HBV-HCC patients.Multivariate Logistic regression showed that the gross pathological classification of tumors was massive or diffuse,multiple tumors,total bilirubin≥17.1μmol/L,and platelet-to-lymphocyte ratio(PLR)≥128.8 were independent risk factors for PVTT(P<0.05);the gross pathological classification of tumors as massive or diffuse,multiple tumors,neutrophil count≥6.3×10^(9)/L were all independent risk factors for EHM in first-diagnosed HBV-HCC patients(P<0.05).The area under the curve of PVTT and EHM prediction nomograms are 0.857 and 0.862,respectively,which have good predictive ability and clinical benefit.Conclusion The nomograms contructed in this study have good individualized predictive value for PVTT and EHM in newly diagnosed HBV-HCC patients,with promising clinical application.

关 键 词：肝细胞癌 门静脉癌栓 肝外转移 列线图 

分 类 号：R735.7[医药卫生—肿瘤]