基于SII、AFP和肿瘤长径的肝细胞癌术前微血管侵犯的预测研究  

Preoperative prediction of microvascular invasion in patients with hepatocellular carcinoma based on SII,AFP and tumor diameter

作　　者：张煌斌 鄢业鸿[1] 万昊[1] 丁左川 周琛 肖建生[1] Zhang Huangbin;Yan Yehong;Wan Hao;Ding Zuochuan;Zhou Chen;Xiao Jiansheng(Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院普外科,南昌330006

出　　处：《中华肝胆外科杂志》2021年第10期733-738,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：江西省应用研究培育计划(20181BBG78042)。

摘　　要：目的探究系统性免疫炎症指数(SII)、甲胎蛋白(AFP)和肿瘤长径对可切除性肝细胞癌患者术前微血管侵犯(MVI)的预测价值,并建立相应的术前预测模型。方法回顾性分析2017年9月至2020年9月在南昌大学第一附属医院行肝癌切除术的283例患者的临床资料。283例肝细胞癌患者中男性249例,女性34例,年龄(53.7±11.0)岁。依据术后病理分为两组:MVI阴性组(n=140)和MVI阳性组(n=143)。收集两组患者的临床资料,多因素logistic回归分析相关指标与MVI的相关性,选取独立危险因素建立MVI的预测模型。Cox比例风险回归模型进行无复发生存期(RFS)的单因素和多因素分析。结果多因素logistic回归分析结果显示,AFP>400 ng/ml(OR=2.304,95%CI:1.329~3.995,P=0.003)、SII>376.30×10^(9)/L(OR=2.249,95%CI:1.299~3.894,P=0.004)以及肿瘤长径>5 cm(OR=2.728,95%CI:1.587~4.687,P<0.001)是肝细胞癌患者MVI的独立危险因素。Cox比例风险回归模型分析提示,AFP(HR=1.663,95%CI:1.063~2.602,P=0.026)和SII(HR=1.851,95%CI:1.173~2.920,P=0.008)是肝细胞癌患者RFS的独立危险因素。基于SII、AFP和肿瘤长径建立的模型预测MVI发生的灵敏度和特异度分别为59.4%和75.7%。结论SII、AFP和肿瘤长径与肝细胞癌患者MVI的发生密切相关,AFP和SII是RFS的独立危险因素,由此建立的预测模型对MVI的发生及患者的预后具有一定的预测价值。Objective To study the predictive value of systemic immune-inflammation index(SII),alpha-fetoprotein(AFP)and tumor diameter on microvascular invasion(MVI)in patients with resectable hepatocellular carcinoma(HCC),with an aim to establish a preoperative prediction model.Methods The clinical data of 283 patients who underwent hepatectomy at the First Affiliated Hospital of Nanchang University from September 2017 to September 2020 were retrospectively analyzed.In the 283 patients with HCC who were included into this study,249 were males and 34 were females,aged(53.7±11.0)years.Using postoperative pathology findings,these patients were divided into two groups:the MVI negative group(n=140)and the MVI positive group(n=143).Correlation between MVI and related indicators was analyzed using logistic regression analysis.The prediction model of MVI was then established by selecting independent risk factors.Univariate and multivariate analysis of recurrence-free survival(RFS)were performed using the Cox proportional hazards regression model.Results Multivariate logistic regression analysis showed that AFP>400 ng/ml(OR=2.304,95%CI:1.329-3.995,P=0.003),SII>376.30×10^(9)/L(OR=2.249,95%CI:1.299-3.894,P=0.004)and tumor diameter>5 cm(OR=2.728,95%CI:1.587-4.687,P<0.001)were independent risk factors for MVI.The Cox proportional hazards regression model showed that AFP(HR=1.663,95%CI:1.063-2.602,P=0.026)and SII(HR=1.851,95%CI:1.173-2.920,P=0.008)were independent risk factors for RFS in HCC patients.The sensitivity and specificity of the model based on SII,AFP and tumor diameter were 59.4%and 75.7%,respectively.Conclusions SII,AFP and tumor diameter were closely related to occurrence of MVI in patients with HCC.AFP and SII were independent prognostic factors of RFS.This prediction model has certain predictive values for occurrence of MVI and prognosis of HCC patients.

关 键 词：癌 肝细胞 微血管 甲胎蛋白类 预后 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]