术前血清γ-谷氨酰转肽酶与血小板比值预测乙型肝炎病毒相关性肝细胞癌患者预后的预测模型构建  

Nomogram based on preoperative serum gamma-glutamyl transpeptidase to platelet ratio for survival prediction of hepatitis B virus-associated hepatocellular carcinoma

作　　者：王金涛 韩博强 安东均 何进程 李红梅 杨林 徐垚 张成 WANG Jintao;HAN Boqiang;AN Dongjun;HE Jincheng;LI Hongmei;YANG Lin;XU Yao;ZHANG Cheng(Department of Hepatobiliary Surgery,Xianyang Central Hospital,Xianyang,Shaanxi 712000,P.R.China)

机构地区：[1]咸阳市中心医院肝胆外科,陕西咸阳712000

出　　处：《中国普外基础与临床杂志》2023年第4期450-455,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探讨术前血清γ-谷氨酰转肽酶与血小板比值(gamma-glutamyl transpeptidase to platelet ratio,GPR)与行根治性切除术的乙型肝炎病毒相关性肝细胞癌(hepatocellular carcinoma,HCC)患者(简称“HCC患者”)预后的关系并建立列线图预测模型。方法 根据纳入和排除标准,回顾性收集2012年1月15日至2018年12月15日期间咸阳市中心医院肝胆外科收治的HCC患者的临床病理资料。应用受试者操作特征曲线确定GPR的最佳临界值,据此将患者分为低GPR组(GPR≤最佳临界值)和高GPR组(GPR>最佳临界值);应用Kaplan-Meier法绘制生存曲线进行生存分析。应用单因素和多因素Cox比例风险回归(简称“Cox回归”)模型分析影响HCC患者总生存期的风险因素,根据筛选出的风险因素构建列线图预测模型,采用一致性指数和校准曲线评估它预测HCC患者3年和5年累积总生存率的效能。结果 共纳入213例患者,GPR的最佳临界值为0.906,其中低GPR组和高GPR组分别为114例和99例。Kaplan-Meier生存曲线分析结果显示,低GPR组1、3、5年累积总生存率分别为99.1%、81.8%、60.6%,高GPR组1、3、5年累积总生存率分别为74.2%、49.1%、35.7%;生存曲线比较结果显示低GPR组的总生存情况优于高GPR组(χ^(2)=25.893,P<0.001)。多因素Cox回归分析结果显示,有微血管侵犯、包膜不完整、术中出血量>1 000 mL、有术后并发症、肿瘤分化程度低分化、TNM分期晚及GPR>0.906患者总生存期缩短的概率增加(P<0.05),以这些因素构建的列线图预测模型对HCC患者术后3年和5年累积总生存率进行预测的一致性系数(95%CI)分别为0.761(0.739,0.783)、0.735(0.702,0.838),校准曲线显示列线图的校正曲线均与理想曲线非常接近。结论 术前GPR与HCC患者预后(总生存)有关,GPR越高的患者预后越差;以此为基础构建的列线图预测模型具有良好的精准度和区分度。Objective To explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio(GPR)and overall survival(OS)of patients with hepatitis B virus-associated hepatocellular carcinoma(Abbreviated as“patients with HCC”),and to establish a nomogram for predicting OS.Methods According to the inclusion and exclusion criteria,the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital,from January 15,2012 to December 15,2018,were retrospectively analyzed.The optimal critical value of GPR was determined by receiver operating characteristic curve,then the patients were divided into a low GPR group(GPR was optimal critical value or less)and high GPR group(GPR was more optimal critical value).The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients.The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC.According to the risk factors of OS for patients with HCC,a nomogram was established.The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated.Results A total of 213 patients were gathered.The optimal critical value of GPR was0.906.There were 114 patients in the low GPR group and 99 patients in the high GPR group.The Kaplan-Meier survival curve analysis showed that the 1-,3-and 5-year accumulative OS rates were 99.1%,81.8%,60.6%in the low GPR group,respectively,which were 74.2%,49.1%,35.7%in the low GPR group,respectively.The OS curve of the low GPR group was better than that of the high GPR group(χ^(2)=25.893,P0.001).The multivariate analysis results showed that the microvascular invasion,incomplete capsule,intraoperative bleeding 1000 mL,postoperative complications,GPR 0.906,low tumor differentiation,and late TNM stage did not contribute to accumulative OS in the patients with HCC(P0.05).The co

关 键 词：γ-谷氨酰转肽酶与血小板比值 原发性肝癌 预后 风险因素 列线图 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学]