建立预测肝细胞癌患者TACE抵抗及预后的临床-影像学联合列线图模型及其价值  

Construction of Clinical-Imaging Based Nomogram Model for the Prediction of Prognosis in Patients with TACE for Hepatocellular Carcinoma and its Clinical Application Value

作　　者：赵张平[1] 李志春 杨翠 邹友健 谢英[1] 虎银宝 岳雷 徐兴明[1] ZHAO Zhangping;LI Zhichun;YANG Cui(Department of Radiology and Imaging,Panzhihua Central Hospital,Panzhihua,Sichuan Province 617067,P.R.China)

机构地区：[1]攀枝花市中心医院放射影像科,617067

出　　处：《临床放射学杂志》2024年第2期230-235,共6页Journal of Clinical Radiology

摘　　要：目的建立肝细胞癌(HCC)经肝动脉化疗栓塞术(TACE)介入治疗预后的临床-影像学联合列线图模型,分析该模型的临床应用价值。方法回顾性分析医院2016年1月至2019年5月164例采用TACE治疗的HCC患者临床及术前CT检查资料,应用风险比例COX回归模型,筛查影响HCC患者TACE抵抗的独立因素,建立联合临床与影像学的列线图模型,并进行模型内部验证,绘制受试者工作特征曲线(ROC),验证该模型区分度和校准度。结果多因素COX回归模型表明,巴塞罗那临床肝癌分期(BCLC)、术前甲胎蛋白(AFP)水平、肿瘤个数、肿瘤最大直径及CT显示肿瘤边界不规则是影响TACE抵抗的HCC患者预后的独立危险因素。根据COX回归模型构建预测列线图,设定预测模型的总分为6分,以3分为分界点,将TACE抵抗的HCC患者分为低危组(0~3分)与高危组(3~6分)。高危组患者的中位生存时间短于低危组患者中位生存时间,生存曲线差异具有统计学意义。采用ROC曲线与校准曲线进行模型的内部验证,结果表明该预测模型具有较好的区分度和校准度。结论基于TACE预后影响因素构建的列线图模型在预测HCC患者TACE抵抗中具有较好的临床应用价值。Objective To construct a clinical-imaging-based nomogram model for the prediction of prognosis in patients with transcatheter arterial chemoembolization(TACE)for(hepatocellular carcinoma,HCC),and to evaluate its clinical application value.Methods Clinical and preoperative CT data of 164 HCC patients treated with TACE from January 2016 to May 2019 were retrospectively analyzed.COX regression model of risk ratio was used to screen the independent factors affecting the prognosis of HCC patients treated with TACE,and a combined clinical and imaging graph model was established.Internal verification of the model was carried out,and receiver operating characteristic curve(ROC)was drawn to verify the differentiation and calibration degree of the model.Results Multivariate COX regression model showed that Barcelona Clinic Liver Cancer(BCLC),alpha-fetoprotein,AFP level,number of tumors,maximum tumor diameter and irregular tumor boundary revealed by CT were independent risk factors for the prognosis of HCC patients treated with TACE.The prediction line chart was constructed according to the COX regression model.The total score of the prediction model was set as 6 points,and the cut-off point was 3 points.The HCC patients treated with TACE were divided into low risk group(0-3 points)and high risk group(3-6 points).median survival time(MST)in high-risk group was shorter than that in lowrisk group,and the difference in survival curve was statistically significant.ROC curve and calibration curve were used to test internal verification of the model,and the results showed that the prediction model had a good degree of differentiation and calibration.Conclusion Nomogram model based on prognostic influencing factors has good clinical application in predicting TACE resistance in HCC patients.

关 键 词：肝细胞癌 化疗栓塞术 抵抗 列线图模型 预后 

分 类 号：R735.7[医药卫生—肿瘤]