肝癌肝切除术后肝衰竭的危险因素分析及列线图模型构建  

Risk factors and nomogram model construction of post-hepatectomy liver failure for hepatocellular carcinoma

作　　者：钟造茂 罗文超 蔡满航 陈显育 钟跃思[1] Zhong Zaomao;Luo Wenchao;Cai Manhang;Chen Xianyu;Zhong Yuesi(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第3期289-295,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81470860)。

摘　　要：目的 探讨肝细胞癌(肝癌)患者肝切除术后肝衰竭(PHLF)发生的危险因素,并构建预测PHLF的列线图模型。方法 回顾性分析2022年1月至2023年4月在中山大学附属第三医院行根治性肝切除术的188例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男165例,女23例;年龄24~75岁,中位年龄55岁。采用Logistic回归分析确定PHLF发生的独立危险因素,构建列线图模型,利用ROC曲线下面积(AUC)和校准曲线评价模型的区分度和校准度,并将模型与现有肝功能综合评分进行比较。结果 患者PHLF发生率25%(47/188),其中A级PHLF患者3例,B级42例,C级2例,其中1例死于PHLF。Logistic回归分析显示,ALT(OR=1.037,95%CI:1.007~1.068)、TB(OR=1.176,95%CI:1.013~1.365)、肿瘤长径(OR=1.414,95%CI:1.148~1.742)、ALBI评分(OR=0.173,95%CI:0.031~0.962)、ICGR15(OR=1.081,95%CI:1.005~1.162)是PHLF发生的独立危险因素(P<0.05)。基于ALT、ICGR15、TB和肿瘤长径构建列线图(ARTL)模型的AUC值达0.816(95%CI:0.747~0.885),具备较好的预测能力,校准曲线和校准预测曲线贴合良好,预测值与观测值较符合。ARTL模型预测效能和临床获益优于ALBI评分(AUC=0.607)、FIB-4指数(AUC=0.672)、APRI评分(AUC=0.730)。结论 ALT、ICGR15、TB、肿瘤长径和ALBI评分是PHLF发生的独立危险因素,构建的ARTL模型具有良好的预测能力,优于现有的3种肝功能综合评分系统。Objective To identify the risk factors of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC),and to construct a nomogram prediction model for PHLF.Methods Clinical data of 188 patients with HCC who underwent radical hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,165 patients were male and 23 female,aged from 24 to 75 years,with a median age of 55 years.The independent risk factors of PHLF were determined by Logistic regression analysis.The nomogram model was constructed.The discrimination and calibration degree of the model were evaluated by using the area under the ROC curve (AUC) and calibration curve.The constructed model was compared with the actual score of comprehensive liver function.Results The incidence of PHLF was 25%(47/188),including3 cases of grade A PHLF,42 cases of grade B and 2 cases of grade C,and one of them died of PHLF.Logistic regression analysis showed that ALT (OR=1.037,95%CI:1.007-1.068),TB (OR=1.176,95%CI:1.013-1.365),maximal tumor diameter (OR=1.414,95%CI:1.148-1.742),ALBI score (OR=0.173,95%CI:0.031-0.962) and ICGR15 (OR=1.081,95%CI:1.005-1.162) were the independent risk factors for PHLF (P<0.05).Based on ALT,ICGR15,TB and maximal tumor diameter (ARTL),the AUC of ARTL model was 0.816 (95%CI:0.747-0.885),indicating it had high predictive capability.The calibration curve and calibration prediction curve fit well,and the predicted value was in high agreement with the observed value.The predictive efficiency and clinical benefit of ARTL model were better than those of ALBI score (AUC=0.607),FIB-4 index (AUC=0.672) and APRI score (AUC=0.730).Conclusions ALT,ICGR15,TB,maximal tumor diameter and ALBI score are the independent risk factors for PHLF.ARTL model has high predictive capability,which is superior to the existing three comprehensive scoring systems fo

关 键 词：肝切除术 癌 肝细胞 肝功能衰竭 列线图 

分 类 号：R735.7[医药卫生—肿瘤] R575.3[医药卫生—临床医学]