构建预测肝细胞肝癌术后CNLC III/IV期复发的网页计算器  

An online calculator predicting recurrence at CNLC III/IV stage of hepatocellular carcinoma after resection

作　　者：黄桂忠 尹鹏飞 林巧红 张建龙[1] HUANG Guizhong;YIN Pengfei;LIN Qiaohong;ZHANG Jianlong(Department of Hepatobiliary Surgery,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangdong Guangzhou 510000,China)

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广东广州510000

出　　处：《现代肿瘤医学》2022年第12期2197-2201,共5页Journal of Modern Oncology

摘　　要：目的:探讨肝细胞肝癌(hepatocellular carcinoma,HCC)术后出现CNLC III/IV期复发危险因素,并构建线上预测模型。方法:回顾性分析我院2011年1月至2017年12月接受肝癌切除术的289例HCC患者临床及病理资料,基于Logistic回归分析明确HCC患者术后出现CNLC III/IV期复发高危因素,并以多因素回归分析结果为基础构建线上预测模型,通过一致性指数(C指数)、校正曲线及临床决策曲线验证该模型预测能力及临床效能。结果:截止至随访日期,共有158例(54.7%)的HCC患者出现术后复发,其中56例(19.4%)为CNLC III/IV期复发。经过多因素Logistic回归分析得术前NLR≥1.56(OR:2.745,95%CI:1.041~7.240,P=0.041)、肿瘤直径≥5.75 cm(OR:3.664,95%CI:1.612~8.328,P=0.002)、肿瘤低分化(OR:4.197,95%CI:2.027~8.688,P<0.001)、微卫星灶(OR:3.426,95%CI:1.241~9.460,P=0.017)及微血管侵犯(OR:3.127,95%CI:1.301~7.514,P=0.011)是术后出现CNLC III/IV复发的危险因素,以此为基础建立相应线上预测计算器,该预测模型时间依赖性受试者工作特征曲线下面积(AUC)为0.862,校正C指数为0.850。结论:HCC患者术后出现CNLC III/IV期复发与诸多因素相关,通过本研究所建立的网页计算器,临床医生可快速简便地识别高危人群并尽早予以干预措施,对临床工作具有指导意义。Objective:To identify the independent risk factors of recurrence at CNLC III/IV stage of hepatocellular carcinoma(HCC)after surgery and then construct an online predictive calculator.Methods:289 HCC patients accepting surgery from January 2011 to December 2017 in our hospital were included in this retrospective study.Logistic multivariate regression analysis was conducted to identify high-risk factors of recurrence at CNLC III/IV stage of HCC after primary resection.Based on the results of logistic regression analysis,we constructed an online predictive model.A concordance index(C-index),calibration curve and clinical decision curve analysis(DCA)were used to validate the performance and clinical utility of the model.Results:158 patients suffered from recurrences,and of these,56 cases diagnosed with recurrence at CNLC III/IV stage.Multivariate analysis of logistic model showed that preoperative neutrophil to lymphocyte ratio(NLR≥1.56)(OR:2.745,95%CI:1.041~7.240,P=0.041),tumour size≥5.75 cm(OR:3.664,95%CI:1.612~8.328,P=0.002),poor differentiation(OR:4.197,95%CI:2.027~8.688,P<0.001),microsatellite lesion(OR:3.426,95%CI:1.241~9.460,P=0.017)and microvascular invasion(OR:3.127,95%CI:1.301~7.514,P=0.011)were high-risk factors of recurrence at CNLC III/IV stage after resection.The area under the time-dependent receiver operating characteristic curve of the developed model was 0.862 with a corrected C index of 0.850.Conclusion:Postoperative CNLC stage III/IV recurrence in HCC patients is associated with many factors.By this easy-to-use online calculator,clinicians could conveniently identify those high risk patients and then provide more personalized therapeutic strategy for them to improve their dismal prognosis.

关 键 词：肝细胞肝癌 CNLC分期 复发 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]