肝细胞癌病人R0切除术后挽救性肝移植退出风险预测模型的构建  

Model for predicting the risk of salvage liver transplantation drop-out in hepatocellular carcinoma patients after R0 hepatectomy

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,Affiliated 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》2022年第2期108-113,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81874149)。

摘　　要：目的分析符合肝移植杭州标准且肿瘤分期处于巴塞罗那临床肝癌分期系统(BCLC)0~A期的肝细胞癌(hepatocellular carcinoma,HCC)病人R0切除术后挽救性肝移植(salvage liver transplantation,SLT)退出的危险因素,并构建SLT退出风险预测模型。方法收集2014年1月至2017年3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。根据术后复发情况是否符合肝移植Milan标准,病人被分为符合组与退出组。随后,根据初次手术相关临床资料构建SLT退出风险预测模型及列线图,并评估其预测能力。最后,应用临床决策曲线评估模型的临床应用价值。结果共180例病人被纳入,包括符合组107例(59.4%)及退出组73例(40.6%)。SLT退出的独立危险因素包括:甲胎蛋白(AFP)分级[比值比(OR)=1.445,95%置信区间(CI)(1.096,1.926),P=0.010],肿瘤直径[OR=1.147,95%CI(1.051,1.259),P=0.003],微血管侵犯(microvascular invasion,MVI)[OR=3.913,95%CI(1.964,8.053),P<0.001]。SLT退出风险预测模型及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0.745,95%CI(0.668,0.822);Hosmer-Lemeshow(H-L)拟合优度检验的P值为0.258。临床决策曲线显示该模型具有一定的临床应用价值。结论HCC病人R0切除术后SLT退出的独立风险因素包括AFP分级、肿瘤直径以及MVI,构建的SLT退出风险预测模型具有较好的风险预测能力。Objective To explore the risk factors of salvage liver transplantation(SLT)drop-out after R0 resection in hepatocellular carcinoma(HCC)patients fulfilling the Hangzhou criteria and Barcelona clinic liver cancer(BCLC)0-A tumor stage and construct a model for predicting the risk of SLT drop-out.Methods From January 2014 to March 2017,clinical data were collected from 180 HCC inpatients fulfilling the inclusion criteria.They were divided into eligible and drop-out groups based upon whether the status of recurrence met the Milan criteria.Then SLT drop-out risk prediction model and risk prediction nomogram were constructed from clinical data of initial operations and their predictive abilities evaluated.Finally clinical decision curve was utilized for evaluating the clinical application value of risk prediction model.Results There were eligible group(n=107,59.4%)and drop-out group(n=73,40.6%).The independent risk factors for SLT drop-out were identified,including alpha fetoprotein(AFP)grade[odds ratio(OR)=1.445,95%confidence interval(CI):1.096,1.926,P=0.010],tumor diameter(OR=1.147,95%CI:1.051,1.259,P=0.003)and microvascular invasion(MVI)(definite)(OR=3.913,95%CI:1.964,8.053,P<0.001).And the model had a decent predictive ability:area under the receiver operating characteristic curve(AUC)was 0.745 with 95%CI 0.668-0.822 and Hosmer-Lemeshow(H-L)test p value 0.258.Finally clinical decision curve indicated that SLT drop-out risk prediction model had decent clinical application value as well.Conclusion Independent risk factors for SLT drop-out in HCC patients after R0 hepatectomy include AFP grade,tumor diameter and MVI.And SLT drop-out risk prediction model shows a decent predictive ability.

关 键 词：肝细胞癌 肝切除术 挽救性肝移植 风险预测模型 

分 类 号：R657.3[医药卫生—外科学]