基于超声和血清学特征的列线图预测肝细胞癌微血管浸润  

A Nomogram Based on Ultrasound and Serological Features Predicts Microvascular Invasion in Hepatocellular Carcinoma

作　　者：李玉珍[1] 谢小华 伍文宁 洪峻峰[1] Li Yuzhen;Xie Xiaohua;Wu Wenning;Hong Junfeng(Department of Ultrasound,The 900 Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Fuzong Clinical Medical College of Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]中国人民解放军联勤保障部队第九○○医院超声科,福建医科大学福总临床医学院,福州市350025

出　　处：《中国超声医学杂志》2024年第5期547-550,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨术前基于超声和血清学特征构建的预测模型对肝细胞癌(HCC)微血管浸润(MVI)的诊断价值。方法回顾性收集手术切除后组织学诊断为HCC患者的临床资料和常规超声图像特征,根据有无MVI分为MVI阳性和MVI阴性。利用Kaplan-Meier(K-M)生存曲线分析MVI对患者无复发生存期的影响;通过单因素和多因素Logistic回归分析确定MVI的独立危险因素。基于独立危险因素构建单一和联合诊断模型预测HCC MVI,并绘制列线图,利用曲线下面积(AUC)、灵敏度、特异度和校准曲线对模型进行评估。结果本研究共纳入92例HCC患者,K-M生存曲线显示MVI阳性是HCC患者无复发生存期的一个显著不良预后因素。单因素和多因素Logistic分析结果表明纤维化-4指数(FIB-4)、肿瘤形状、肿瘤边界是MVI的独立危险因素。将上述指标进行单一和联合诊断,联合诊断模型AUC为0.865(95%CI:0.778~0.928),灵敏度为82.5%,特异度为84.6%。校准曲线显示列线图预测结果与实际结果一致性良好。结论基于FIB-4、肿瘤形状、肿瘤边界构建的列线图能较好地在术前预测MVI的概率,可以根据MVI发生的风险调整HCC的治疗计划,对临床决策有一定指导作用。Objective To investigate the diagnostic value of microvascular invasion(MVI)in hepatocellular carcinoma(HCC)model based on ultrasound and serological features in prediction of before operation.Methods The clinical data and conventional ultrasound image features of patients diagnosed by as HCC histopathology after surgical resection were retrospectively collected,and they were divided into MVI positive group and MVI negative group according to the presence of MVI.Kaplan-Meier survival curve was used to analyze the effect of MVI on recurrence-free survival.Independent risk factors for MVI were determined by univariate and multivariate Logistic regression analysis.Then,a single model and a combined diagnostic model were constructed to predict MVI based on independent risk factors.A nomogram was drawn and eraluated by area under the curve(AUC),sensitivity,specificity,and calibration curve.Results A total of 92 HCC patients were included in this study.Kaplan-Meier survival curve showed that MVI positive was a significant adverse prognostic factor for recurrence-free survival.Univariate and multivariate Logistic analysis showed that fibrosis-4 index(FIB-4),tumor shape and tumor boundary were independent risk factors for MVI.The single and combined diagnosis using above indicators were performed.The AUC of the combined diagnosis model was 0.865(95%CI:0.778-0.928),the sensitivity was 82.5%,and the specificity was 84.6%.The calibration curve showed that the predicted result of the nomogram was in good agreement with the actual result.Conclusions The nomogram constructed based on FIB-4,tumor shape and tumor boundary could predict the probability of MVI before surgery,and could adjust the treatment plan of HCC according to the risk of MVI occurrence,which has a certain guiding effect on clinical decision-making.

关 键 词：肝细胞癌 微血管浸润 超声 纤维化-4指数 列线图 诊断 

分 类 号：R73[医药卫生—肿瘤]