肝内胆管细胞癌患者解剖性肝切除术后预后影响因素分析及列线图模型构建  

Influencing factors of prognosis of intrahepatic cholangiocarcinoma after anatomical hepatectomy and construction of nomogram model

作　　者：周阳 尹星[1] 付民 常欢 邢艳丽[1] 李毅星[1] 尹先哲[1] ZHOU Yang;YIN Xing;FU Min;CHANG Huan;XING Yanli;LI Yixing;YIN Xianzhe(Department of Oncology,the Second People's Hospital of Nanyang,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第二人民医院肿瘤科,河南南阳473000

出　　处：《中华实用诊断与治疗杂志》2024年第2期179-183,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(2018020992)。

摘　　要：目的分析肝内胆管细胞癌(ICC)患者行解剖性肝切除术后预后不良的影响因素,构建列线图模型并验证其预测价值。方法2016年1月—2018年8月南阳市第二人民医院诊治ICC患者147例,均行解剖性肝切除术治疗,术后随访5年,根据生存情况分为预后不良组67例和预后良好组80例。比较2组术前Child-Pugh分级、TNM分期、肿瘤数目、肿瘤位置、淋巴结转移、血管侵犯、血清糖类抗原19-9(CA19-9)水平等临床资料,采用多因素logistic回归分析ICC患者行解剖性肝切除术后预后不良的影响因素;根据影响因素构建预测ICC患者行解剖性肝切除术后预后不良的列线图模型;绘制ROC曲线和校准曲线,评估列线图模型的区分度和校准度。结果预后不良组多发肿瘤、有淋巴结转移、血管侵犯、血清CA19-9>89 u/mL比率(29.9%、37.3%、25.4%、71.6%)均高于预后良好组(11.2%、16.3%、10.0%、47.5%)(P<0.05),肿瘤最大径[(6.21±1.48)cm]长于预后良好组[(3.45±1.33)cm](t=11.902,P<0.001),Child-Pugh分级、TNM分期、肿瘤位置、病理分型、血清甲胎蛋白及高血压、糖尿病、吸烟、饮酒、腹腔积液、乙型肝炎表面抗原阳性比率与预后良好组比较差异均无统计学意义(P>0.05)。多发肿瘤(OR=32.122,95%CI:3.772~273.581,P=0.002)、肿瘤最大径(OR=5.762,95%CI:3.055~10.870,P<0.001)、有淋巴结转移(OR=10.591,95%CI:1.978~56.704,P=0.006)、血管侵犯(OR=10.757,95%CI:1.591~72.747,P=0.015)、血清CA19-9>89 u/mL(OR=7.165,95%CI:1.640~31.314,P=0.009)是ICC患者行解剖性肝切除术后预后不良的影响因素。列线图模型预测ICC患者行解剖性肝切除术后预后不良的AUC为0.956(95%CI:0.924~0.988,P<0.001),灵敏度为88.1%,特异度为80.6%。列线图模型的校准曲线与理想曲线的拟合情况较好。结论多发肿瘤、肿瘤最大径、有淋巴结转移、血管侵犯、血清CA19-9>89 u/mL是ICC患者行解剖性肝切除术后预后不良的影响因素,基于上述指标�Objective To analyze the influencing factors of poor prognosis of intrahepatic cholangiocarcinoma(ICC)after anatomical hepatectomy,to construct the nomogram model and to verify the predictive value of the nomogram model.Methods From January 2016 to August 2018,147 patients with ICC were performed anatomical hepatectomy in the Second People's Hospital of Nanyang,and were divided into poor prognosis group(n=67)and good prognosis group(n=80)according to the 5-year survival.The preoperative clinical data as Child-Pugh classification,TNM stage,tumor number,tumor location,lymph node metastasis,vascular invasion,and serum carbohydrate antigen 19-9(CA19-9)level were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of poor prognosis of ICC patients after anatomical hepatectomy.A nomogram model was constructed based on the influencing factors to predict the poor prognosis of ICC patients after anatomical hepatectomy,ROC curve and calibration curve were plotted to evaluate the discrimination and calibration of the nomogram model.Results The rates of multiple tumors,lymph node metastasis,vascular invasion,and serum CA19-9>89 u/mL were higher in poor prognosis group(29.9%,37.3%,25.4%,71.6%)than those in good prognosis group(11.2%,16.3%,10.0%,47.5%)(P<0.05),the maximum diameter of the tumor was longer in poor prognosis group[(6.21±1.48)cm]than that in good prognosis group[(3.45±1.33)cm](t=11.902,P<0.001),and there were no significant differences in the Child-Pugh classification,TNM stage,tumor location,pathological classification,serum alpha-fetoprotein,and the rates of hypertension,diabetes,smoking habits,alcohol consumption,peritoneal fluid,and positive hepatitis B surface antigen between two groups(P>0.05).Multiple tumors(OR=32.122,95%CI:3.772-273.581,P=0.002),maximum diameter of the tumor(OR=5.762,95%CI:3.055-10.870,P<0.001),lymph node metastasis(OR=10,591,95%CI:1.978-56.704,P=0.006),vascular invasion(OR=10.757,95%CI:1.591-72.747,P=0.015),and serum CA19-9>89 u/mL(OR

关 键 词：肝内胆管细胞癌 解剖性肝切除术 预后 列线图模型 淋巴结转移 糖类抗原19-9 

分 类 号：R735.8[医药卫生—肿瘤]