影像学特征和临床检验指标对HBV相关小肝癌术后早期复发的危险因素分析  

A study of preoperative risk factors for early recurrence of HBV-associated small hepatocellular carcinoma based on imaging and clinical test indexes

作　　者：杨刚 张宇波 张伟[1] 张丹阳 雷鹏[2] Yang Gang;Zhang Yubo;Zhang Wei;Zhang Danyang;Lei Peng(Graduate School of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学研究生院,银川750004 [2]宁夏医科大学总医院肝胆外科,银川750004

出　　处：《中国基层医药》2024年第5期722-728,共7页Chinese Journal of Primary Medicine and Pharmacy

基　　金：宁夏回族自治区重点研发计划 (2018BEG03001)。

摘　　要：目的分析临床检验指标及影像学特征对乙型肝炎病毒(HBV)相关小肝癌术后早期复发的相关危险因素。方法回顾性收集2017年1月至2021年8月宁夏医科大学总医院肝胆外科因HBV相关小肝癌行肝癌根治术治疗的患者163例的临床资料。按术后2年内是否复发分为早期复发组87例和未早期复发组76例,排除各项指标共线性的情况后,采用单因素和多因素logistic回归分析确立术后肿瘤复发的独立危险因素,并构建临床预测模型,以列线图进行可视化呈现,通过受试者工作特征曲线(ROC曲线)及校准曲线对列线图模型预测能力进行评价。最后采用Cox回归分析确定独立危险因素与复发时间的关系。结果单因素分析显示:早期复发组术前γ-谷氨酰转肽酶与淋巴细胞计数比值(GLR)>35.79[41.38%(36/87)]、肿瘤多发[25.29%(22/87)]、存在瘤周水肿[45.98%(40/87)]、瘤内小动脉团[50.58%(44/87)]及年龄≥60岁[74.71%(65/87)]的患者数量和比例都明显高于非早期复发组(χ^(2)=5.73、3.78、3.97、3.73、3.75,均P<0.05)。logistics多因素分析显示,GLR>35.79及存在瘤周水肿是HBV相关小肝癌行肝癌根治术后早期复发的独立危险因素(OR=2.22、1.99,95%CI:为1.10~4.59、1.00~3.99,均P<0.05)。建立列线图预测模型,ROC曲线中C指数为0.70(95%CI:0.60~0.79),校准曲线中的Brier Score为0.22,模型区分度及准确度良好。Cox回归分析显示GLR>35.79与存在瘤周水肿是影响HBV相关小肝癌切除术后复发时间的危险因素。结论GLR>35.79及存在瘤周水肿是HBV相关小肝癌行肝癌切除术后早期复发的独立危险因素,构建的临床预测模型具有良好的预测效能。Objective To investigate the predictive values of clinical test indexes and imaging indexes for early postoperative recurrence of hepatitis B virus(HBV)-related small hepatocellular carcinoma.Methods Clinical case data of 163 patients with HBV-related small hepatocellular carcinoma undergoing radical hepatectomy at the Department of Hepatobiliary Surgery in the General Hospital of Ningxia Medical University from January 2017 to August 2021 were retrospectively collected.The patients were categorized into 87 cases in an early recurrence group and 76 cases in a non-early recurrence group according to whether or not they had recurrence within 2 years after surgery.After excluding the covariance of various indicators,independent risk factors for postoperative tumor recurrence were established using univariate analysis and multivariate logistic regression analysis.A clinical prediction model was constructed and presented visually in a nomogram diagram,and the predictive ability of the nomogram diagram model was evaluated using receiver operating characteristic curves as well as calibration curves.Cox regression analysis was used to determine the relationship between independent risk factors and time to recurrence.Results Univariate analysis showed that in the early recurrence group,the number and proportion of patients with preoperative gamma-glutamyl transferase to lymphocyte count ratio(GLR)>35.79[41.38%(36/87)],tumor multiplicity[25.29%(22/87)],the presence of peritumoral edema[45.98%(40/87)],intratumoral small arterial clusters[50.58%(44/87)],and age≥60 years[74.71%(65/87)]were significantly higher than those in the non-early recurrence group(χ^(2)=5.73,3.78,3.97,3.73,3.75,all P<0.05).Multivariate logistic regression analysis showed that GLR>35.79 and the presence of peritumoral edema were independent risk factors for early recurrence after radical hepatectomy of HBV-related small hepatocellular carcinomas[odds ratio(OR)=2.22,1.99,95%confidence interval(CI):1.10-4.59,1.00-3.99,P<0.05].The nomogram diagram predi

关 键 词：癌 肝细胞 乙型肝炎 肝切除术 复发 列线图 预测 危险因素 临床研究 

分 类 号：R735.7[医药卫生—肿瘤]