基于术前资料的肝细胞癌微血管侵犯风险评分模型的建立  

Construction of a microvascular invasion risk scoring model for hepatocellular carcinoma based on preoperative data

作　　者：董碧菁 王莉[2] 刘治坤 DONG Bijing;WANG Li;LIU Zhikun(Forth Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China;Department of Hepatobiliary Surgery,Hangzhou First People’s Hospital,Hangzhou 311199,Zhejiang,China)

机构地区：[1]浙江中医药大学第四临床医学院,浙江杭州310053 [2]杭州市第一人民医院肝胆外科,浙江杭州311199

出　　处：《中国现代医生》2024年第4期38-42,共5页China Modern Doctor

摘　　要：目的基于肝细胞癌(hepatocellular carcinoma,HCC)患者的术前资料建立微血管侵犯(microvascular invasion,MVI)风险评分模型。方法回顾性分析2000年1月至2021年12月于杭州市第一人民医院行肝切除术的1153例HCC患者的临床资料。采用随机抽样的方法以3∶1的比例将样本分为建模组(n=864)和验证组(n=289)。建模组采用Logistic回归分析模型探讨MVI的独立危险因素并据此建立预测模型。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)和校正曲线评价风险模型的预测能力和性能。结果建模组患者MVI的发生率为24.1%(208/864)。多因素Logistic回归分析发现甲胎蛋白(alpha-fetoprotein,AFP)>160ng/ml、总肿瘤体积(total tumor volume,TTV)>30cm3均是患者发生MVI的独立危险因素(P<0.05)。建立的风险评分模型总分6分,0~1分为低危,2~3分为中危,4~6分为高危。该模型预测建模组患者发生MVI的曲线下面积(area under the curve,AUC)为0.714,验证组AUC为0.731。校准图显示该预测模型性能良好。结论基于TTV和AFP建立的HCC患者MVI风险预测模型简单、易用,有利于术前选择治疗决策和医患沟通。Objective Microvascular invasion(MVI)risk scoring model was established based on the preoperative data of hepatocellular carcinoma(HCC)patients.Methods The clinical data of 1153 HCC patients who underwent hepatectomy in Hangzhou First People’s Hospital from January 2000 to December 2021 were retrospectively analyzed.Random sampling method was used to divide the samples into modeling group(n=864)and verification group(n=289)at a ratio of 3:1.The modeling group used Logistic regression analysis model to explore the independent risk factors of MVI and established a prediction model accordingly.Receiver operating characteristic(ROC)curve and correction curve were drawn to evaluate the predictive ability and performance of the risk model.Results The incidence of MVI was 24.1%(208/864)in modeling group.Multivariate Logistic regression analysis showed that alpha-fetoprotein(AFP)>160ng/ml and total tumor volume(TTV)>30cm3 were independent risk factors for MVI(P<0.05).The total score of risk scoring model was 6 points,0-1 was classified as low risk,2-3 was classified as medium risk,and 4-6 was classified as high risk.The model predicted that the area under the curve(AUC)of MVI was 0.714 in modeling group and 0.731 in verification group.The calibration diagram showed that the prediction model had good performance.Conclusion The MVI risk prediction model for HCC patients based on TTV and AFP is simple and easy to use,which is conducive to preoperative treatment decision-making and doctor-patient communication.

关 键 词：肝细胞癌 微血管侵犯 风险模型 甲胎蛋白 总肿瘤体积 

分 类 号：R735.7[医药卫生—肿瘤]