肝细胞癌微血管侵犯术前预测因素及价值探讨  

Preoperative Predictive Factors and Value of Microvascular Invasion in Hepatocellular Carcinoma

作　　者：周小泉 赵凯亮[1] 王卫星[1] ZHOU Xiao-quan;ZHAO Kai-liang;WANG Wei-xing(Department of Hepatobiliary Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肝胆外科,武汉430060

出　　处：《微循环学杂志》2023年第2期55-60,共6页Chinese Journal of Microcirculation

摘　　要：目的:探讨肝细胞癌(HCC)患者术前微血管侵犯(MVI)危险因素及其评分对MVI的预测价值。方法:回顾性分析2019-12-2022-07武汉大学人民医院148例根治性肝切除术HCC患者术前临床资料。根据有无MVI分为MVI阳性组(61例)和MVI阴性组(87例)。统计分析中性粒细胞、淋巴细胞、D-二聚体(D-D)、白蛋白(NLDA)评分、异常凝血酶原-II(PIVKA-II)、肿瘤直径等指标与MVI的关系;通过相关系数(r)矩阵进行多重共线性检验,排除r较高的变量,再行多因素Logistic回归分析MVI的独立危险因素;应用受试者工作特征曲线(ROC)分析独立危险因素评分对MVI的预测价值。结果:单因素分析显示,肿瘤直径>6.75cm、甲胎蛋白(AFP)>400ng/ml、PIVKA-II>152mAU/ml、D-D>0.5mg/L、中性粒细胞/淋巴细胞比值(NLR)>2.47、NLDA评分>0.025与HCC患者MVI阳性相关(P<0.05或P<0.01)。经排除多重共线性变量D-D和NLR后的多因素Logistic回归分析表明,肿瘤直径>6.75cm、PIVKA-II>152mAU/ml及NLDA评分>0.025是HCC患者MVI的独立危险因素(P<0.05或P<0.01)。以上独立危险因素评分>1可诊断为MVI阳性,其ROC曲线下面积为0.755,灵敏度为75.40%,特异度为63.20%。结论:术前NLDA评分、PIVKA-II、肿瘤直径是HCC患者发生MVI的独立危险因素,其评分>1对预测MVI的发生有一定价值。Objective:To investigate the risk factors of preoperative microvascular invasion(MVI)and the predictive value of its score on MVI in patients with hepatocellular carcinoma(HCC).Method:The preoperative clinical data of 148 HCC patients who underwent curative liver resection from December 2019 to July 2022 were retrospectively reviewed.They were divided into the MVI positive group(61 patients)and the MVI negative group(87 patients)according to the presence or absence of MVI.Analysis the relationships between the indices of neutrophils,lymphocytes,D-dimer,albumin(NLDA)score,protein induced by vitamin K absence/antagonist-Ⅱ(PIVKA-II),and tumor diameter and MVI were evaluated.Multiple collinearity test was performed by correlation coefficient matrix to exclude variables with higher r,then multivariate logistic regression was performed to analyze the independent risk factors of MVI,and receiver operating characteristic curve(ROC)was applied to analyze the predictive value of independent risk factor score for MVI.Results:In univariate analysis,tumor diameter>6.75cm,alpha fetoprotein(AFP)>400ng/ml,PIVKA-II>152mAU/ml,D-D>0.5mg/L,NLR>2.47,and NLDA score>0.025 were associated with positive MVI in HCC patients(P<0.05 or P<0.01).After excluding the multicollinearity variables D-D and NLR,the results of multivariate logistic regression analysis indicated that tumor diameter>6.75cm,PIVKA-II>152mAU/ml and NLDA score>0.025 were independent risk factors for MVI in HCC patients(P<0.05 or P<0.01).The above independent risk factor score>1 was diagnostic of MVI positivity,and its area under the ROC curve was 0.755,with a sensitivity of 75.40%and a specificity of 63.20%.Conclusion:Preoperative NLDA score,PIVKA-II,and tumor diameter were independent risk factors for the development of MVI in HCC patients,and its score>1 was valuable in predicting the occurrence of MVI.

关 键 词：肝细胞癌 微血管侵犯 NLDA评分 PIVKA-II 肿瘤直径 

分 类 号：R735.7[医药卫生—肿瘤]