一项构建BCLC 0~A期肝细胞癌病人R0切除术后肝内早期复发风险预测列线图的回顾性研究  

Nomogram for predicting the risk of early recurrence in BCLC 0-A stage hepatocellular carcinoma patients after R0 hepatectomy:a retrospective study

作　　者：陈姚 张万广[1] 陈孝平 陈义发[1] Chen Yao;Zhang Wanguang;Chen Xiaoping;Chen Yifa(Hepatic Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科,湖北武汉430030

出　　处：《腹部外科》2021年第6期447-452,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81874149)。

摘　　要：目的分析巴塞罗那临床肝癌(BCLC)0~A期肝细胞癌(hepatocellular carcinoma,HCC)病人R0切除术后肝内早期复发的危险因素,并构建肝内早期复发风险预测列线图。方法收集2014年1月至2016年12月在华中科技大学同济医学院附属同济医院肝脏外科就诊且符合纳入标准的HCC病人资料。依据无复发生存时间是否超过2年,病人被分成早期复发组与非早期复发组。根据术前相关临床资料构建早期复发风险预测模型与列线图,并评估其预测能力。最后,应用临床决策曲线评估风险预测模型的临床应用价值。结果共315例病人被纳入,包含早期复发组120例(38.1%)和非早期复发组195例(61.9%)。早期复发的独立危险因素包括:习惯性饮酒(是)[P=0.019,比值比(OR)=1.994,95%置信区间(CI)(1.123,3.561)],病毒性肝炎(是)[P=0.004,OR=4.480,95%CI(1.736,13.707)],lnAFP[P=0.039,OR=1.094,95%CI(1.005,1.191)],肿瘤数目(多发)[P<0.001,OR=6.468,95%CI(2.702,16.543)],肿瘤直径[P=0.001,OR=1.170,95%CI(1.082,1.271)],肿瘤包膜(是)[P=0.004,OR=0.448,95%CI(0.258,0.773)]。早期复发风险预测模型与列线图预测能力评价:受试者工作特征曲线下面积(AUC)的值为0.754,95%CI(0.700,0.808);Hosmer-Lemeshow(H-L)拟合优度检验:P=0.096。临床决策曲线显示该模型具有一定的临床应用价值。结论习惯性饮酒、病毒性肝炎、lnAFP、肿瘤数目、肿瘤直径和肿瘤包膜是BCLC 0~A期HCC病人R0切除术后早期复发的独立危险因素。早期复发风险预测列线图在识别早期高复发风险人群方面表现出了较好的能力。Objective To explore the risk factors of early intrahepatic recurrence in Barcelona clinic liver cancer(BCLC)0-A stage hepatocellular carcinoma(HCC)patients after R0 hepatectomy and develop a nomogram for predicting the risk of early intrahepatic recurrence.Methods From January 2014 and December 2016,clinical data were collected from 315 HCC inpatients fulfilling the inclusion criteria.They were classified into early recurrence and non-early recurrence groups based upon whether recurrence-free survival was longer than 2 years.Then,on the basis of preoperative clinical data,model and nomogram for predicting the risk of early recurrence were developed and their predictive performances evaluated.Results There were early recurrence group(n=120,38.1%)and non-early recurrence group(n=195,61.9%).The independent risk factors for early recurrence were identified,including habitual drinking(definite)(P=0.019,OR=1.994,95%CI:1.123-3.561),viral hepatitis(definite)(P=0.004,OR=4.480,95%CI:1.736-13.707),lnAFP(P=0.039,OR=1.094,95%CI:1.005-1.191),number of tumor(multiple)(P<0.001,OR=6.468,95%CI:2.702-16.543),tumor diameter(P=0.001,OR=1.170,95%CI:1.082-1.271)and tumor capsule(definite)(P=0.004,OR=0.448,95%CI:0.258-0.773).And the predictive ability of model was evaluated as follows:area under receiver operating characteristic curve(AUC)was 0.754 with 95%CI(0.700-0.808)and H-L test P value 0.096.Clinical decision curve indicated that early recurrence risk prediction model had decent clinical application value as well.Conclusion Habitual drinking,viral hepatitis,lnAFP,number of tumor,tumor diameter and tumor capsule are independent risk factors for early recurrence after R0 hepatectomy in BCLC 0-A stage HCC patients.And early recurrence risk prediction nomogram demonstrates a decent ability of identifying patients with a high risk of early recurrence.

关 键 词：肝细胞癌 肝切除术 早期复发 列线图 

分 类 号：R657.3[医药卫生—外科学]