原发性肝癌患者术后并发肝衰竭的危险因素分析及Nomogram预测模型构建  

Analysis of Risk Factors and Nomogram Prediction Model for Postoperative Liver Failure in Patients with Primary Liver Cancer

作　　者：车汉洋 钟雅俊 陈志辉[1] 吕昕亮[1] CHE Hanyang;ZHONG Yajun;CHEN Zhihui(Lishui Municipal Central Hospital,Zhejiang 323000,China)

机构地区：[1]丽水市中心医院,323000

出　　处：《医学研究杂志》2023年第5期163-166,143,共5页Journal of Medical Research

基　　金：浙江省丽水市科技计划项目(2017GYXL1)。

摘　　要：目的分析原发性肝癌患者术后并发肝衰竭的危险因素,并构建Nomogram模型。方法收集2018年10月~2021年9月于笔者医院行手术治疗的183例原发性肝癌患者临床资料。采用ROC曲线分析获取有统计学意义的连续性变量的最佳截断值。采用多因素Logistic回归模型分析原发性肝癌患者术后并发肝衰竭的危险因素。构建预测原发性肝癌患者术后并发肝衰竭的Nomogram模型,采用校正曲线对Nomogram模型进行内部验证和性能评价,决策曲线对Nomogram模型的预测效能进行临床净收益评估。结果纳入研究的183例患者中有11例术后并发肝衰竭。ROC曲线分析显示,年龄、血小板计数的AUC分别为0.699、0.751;最佳截断值分别为70岁、90×10^(9)/L。合并血管癌栓(是)、肿瘤直径>10cm、术前肝功能Child-Pugh分级(B级)、术中出血量>1000ml是原发性肝癌患者术后并发肝衰竭的独立危险因素。内部验证结果显示,Nomogram模型预测原发性肝癌患者术后并发肝衰竭的C指数为0.743(95%CI:0.687~0.938)。Nomogram模型预测原发性肝癌患者术后并发肝衰竭的阈值>0.14,Nomogram模型提供临床净收益。结论本研究基于合并血管癌栓、肿瘤直径、术前肝功能Child-Pugh分级、术中出血量构建了预测原发性肝癌患者术后并发肝衰竭的Nomogram模型,该模型可提高预测原发性肝癌患者术后并发肝衰竭的准确性,具有较好的临床效能。Objective To analyze the risk factors of postoperative liver failure in patients with primary liver cancer and construct a Nomogram model.Methods The clinical data of 183 patients with primary liver cancer who underwent surgical treatment in our hospital from October 2018 to September 2021 were collected.The receiver operating characteristic(ROC)curve analysis was used to obtain the optimal truncations of continuous variables with statistical significance.Multivariate Logistic regression model was used to analyze the risk factors of liver failure in patients with primary liver cancer.To construct a Nomogram model to predict postoperative liver failure in patients with primary liver cancer,internal verification and performance evaluation of the Nomogram model were conducted using the correction curve,and the net benefit of the Nomogram model was evaluated using the decision curve.Results Of the 183 patients included in the study,11had postoperative liver failure.ROC curve analysis showed that the AUC of age and platelet count were 0.699 and 0.751,respectively.The optimal cut-point values were 70 years and 90×10^(9)/L,respectively.The independent risk factors for liver failure in patients with primary liver cancer were vascular thrombectomy(yes),tumor diameter>10cm,Child-Pugh grade of preoperative liver function(GRADE B),and intraoperative blood loss>1000ml.Internal validation results showed that the Nomogram model can predict liver failure in patients with primary liver cancer with a C-index of 0.743(95%CI:0.687-0.938).The threshold of Nomogram model to predict postoperative liver failure in patients with primary liver cancer is>0.14,and the Nomogram model provides a net clinical benefit.Conclusion This study constructed a Nomogram model to predict postoperative liver failure in patients with primary liver cancer based on vascular tumor thrombectomy,tumor diameter,Child-Pugh preoperative liver function grade and intraoperative blood loss,which can improve the accuracy of predicting postoperative liver failure in

关 键 词：原发性肝癌术后 肝衰竭 危险因素 Nomogram模型 

分 类 号：R735.7[医药卫生—肿瘤]