列线图预测肝细胞癌合并门静脉癌栓预后  

Nomogram on predicting the prognosis of hepatocellular carcinoma with portal vein tumor thrombus

作　　者：魏天桐 梁保丽[2] 刘慧敏[3] 姚鹏[4] Wei Tiantong;Liang Baoli;Liu Huimin;Yao Peng(Office of Infection Management,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Traditional Chinese Medicine,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Integrated Centre of Traditional Chinese and Western Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Infectious Diseases,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院感染管理办公室,北京100043 [2]河北医科大学第三医院中医科,石家庄050051 [3]首都医科大学附属北京地坛医院中西医结合中心,北京100015 [4]首都医科大学附属北京朝阳医院感染与肝病科,北京100043

出　　处：《中国肝脏病杂志（电子版）》2022年第3期28-38,共11页Chinese Journal of Liver Diseases：Electronic Version

基　　金：首都卫生发展科研专项基金资助(2016-4-2172)。

摘　　要：目的构建可用于预测肝细胞癌(hepatocellular carcinoma,HCC)合并门静脉癌栓(portal vein tumor thrombus,PVTT)患者预后的列线图风险模型。方法回顾性纳入2010年1月至2019年12月河北医科大学第三医院收治的316例HCC合并PVTT患者为研究对象,采用随机数字表法按照7∶3分为建模组(224例)和验证组(92例)。收集患者一般资料包括年龄、性别、肝癌家族史、吸烟史、饮酒史等。实验室指标包括白细胞计数(white blood cell,WBC)、中性粒细胞计数与淋巴细胞计数比值(neutrophil-to-lymphocyte ratio,NLR)、血红蛋白(hemoglobin,HGB)、血小板计数(platelet count,PLT)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBil)、白蛋白(albumin,ALB)、乳酸脱氢酶(lactate dehydrogenase,LDH)、γ-谷氨酰转移酶(gamma-glutamyltransferase,GGT)、碱性磷酸酶(alkaline phosphatase,ALP)、肌酐(creatinine,Cr)、凝血酶原活动度(prothrombin,PTA)、国际标准化比值(international normalized ratio,INR)、甲胎蛋白(alpha-fetoprotein,AFP)和C反应蛋白(C-reactive protein,CRP)。采用单因素和多因素Cox回归分析HCC合并PVTT患者1年病死的影响因素,绘制列线图模型、BCLC分期、MELD、Child-Pugh评分、ALBI分级预测患者预后的受试者工作特征(receiver operator characteristic,ROC)曲线,利用R软件建立预测患者预后的列线图模型,并验证模型的区分度与一致性。结果腹水(HR=1.46,95%CI:1.07~1.99)、上消化道出血(HR=2.54,95%CI:1.62~3.99)、PLT>100×10^(9)/L(HR=1.53,95%CI:1.11~2.11)、ALT>50 U/L(HR=1.41,95%CI:1.00~2.08)、TBil>18.8μmol/L(HR=1.61,95%CI:1.13~2.29)、AFP>400μg/L(HR=1.49,95%CI:1.07~2.07)、CRP>5 mg/L(HR=2.85,95%CI:1.72~4.72)是HCC合并PVTT患者预后的独立危险因素(P均<0.05)。建模组和验证组列线图模型的ROC曲线下面积分别为0.787(95%CI:0.713~0.860)和0.840(95%CI:0.740~0.940),差异无统计学意义Objective To construct a nomogram risk model that can be used to predict the prognosis of hepatocellular carcinoma(HCC)patients with portal vein tumor thrombus(PVTT).Methods Total of 370 HCC patients with PVTT in the Third Hospital of Hebei Medical University from January 2010 to December 2019 were retrospectively involved and divided into training set(224 cases)and test set(92 cases)according to the randomization principle of 7∶3.The clinical data including age,gender,family history of liver cancer,history of smoking and drinking were collected.Laboratory indicators included white blood cell(WBC),neutrophil-to-lymphocyte ratio(NLR),hemoglobin(HGB),platelet count(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),albumin(ALB),lactate dehydrogenase(LDH),gamma-glutamyltransferase(GGT),alkaline phosphatase(ALP),creatinine(Cr),prothrombin(PTA),international normalized ratio(INR),alpha-fetoprotein(AFP)and C-reactive protein(CRP).Univariate and multivariate Cox regression were used to analyze the factors affecting 1-year mortality of HCC patients with PVTT,R software was used to build and verify the nomogram mode.Receiver operator characteristic(ROC)curve was used to evaluate the predict value of the nomogram model,BCLC stage,MELD score,Child-Pugh score,and ALBI grade.Results Ascites(HR=1.46,95%CI:1.07~1.99),upper gastrointestinal bleeding(HR=2.54,95%CI:1.62~3.99),PLT>100×10^(9)/L(HR=1.53,95%CI:1.11~2.11),ALT>50 U/L(HR=1.41,95%CI:1.00~2.08),TBil>18.8μmol/L(HR=1.61,95%CI:1.13~2.29),AFP>400μg/L(HR=1.49,95%CI:1.07~2.07)and CRP>5 mg/L(HR=2.85,95%CI:1.72~4.72)were independent risk factors for the prognosis of HCC patients with PVTT(P<0.05).The area under ROC curve of nomogram model in model group and verification group based on the above seven factors were 0.787(95%CI:0.713~0.860)and 0.840(95%CI:0.740~0.940),respectively,the difference was not statistically significant(z=-0.842,P=0.4).The area under ROC curve of nomogram model in model group and verification group were significantl

关 键 词：肝细胞癌 门静脉癌栓 列线图 预后 

分 类 号：R735.7[医药卫生—肿瘤]