基于临床、常规超声及超声造影的列线图术前鉴别肝细胞癌和肝内胆管癌  

A nomogram based on clinical,ultrasound and contrast-enhanced ultrasound features for preoperative differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

作　　者：刘春蕊 薛海燕 刘晗 万鹏[2] 孔文韬[1] 周正扬[3] 姚静 Liu Chunrui;Xue Haiyan;Liu Han;Wan Peng;Kong Wentao;Zhou Zhengyang;Yao Jing(Department of Ultrasound,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;College of Computer Science and Technology,Nanjing University of Aeronautics and Astronautics,Nanjing 210016,China;Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院超声医学科,南京210008 [2]南京航空航天大学计算机科学与技术学院,南京210016 [3]南京大学医学院附属鼓楼医院医学影像科,南京210008

出　　处：《中华超声影像学杂志》2024年第5期369-377,共9页Chinese Journal of Ultrasonography

基　　金：国家科技部重点研发计划(SQ2020YFA0713800);国家自然科学基金(81771844,82371981)。

摘　　要：目的建立和验证基于临床及超声影像特征的列线图术前鉴别肝细胞癌(HCC)和肝内胆管癌(ICC)。方法回顾性分析2016年1月至2023年12月南京大学医学院附属鼓楼医院因肝占位入院的462例患者的临床和超声资料,包括HCC 262例(56.7%),ICC 200例(43.3%)。按7∶3比例随机分为训练集(n=324)和验证集(n=138)。单因素分析初步筛选训练集中HCC组与ICC组两组间差异有统计学意义的变量,行LASSO回归选取系数较高的变量,纳入Logistic回归,分析预测病理为ICC的独立危险因素。R软件绘制基于上述危险因素的列线图。采用ROC曲线、校准曲线评估列线图鉴别ICC的能力,决策曲线(DCA)分析模型给患者带来的净收益。结果单因素分析示训练集ICC组与HCC组中年龄、性别、肝硬化、HBsAg(+)、ALP>185 U/L、CA19-9>27 kU/L、CA242>10 kU/L、形状(不规则)、边界、胆管扩张、门静脉癌栓、动脉期增强方式、廓清时间<60 s、瘤内静脉等差异有统计学意义(均P<0.05)。LASSO回归分析选取系数靠前的10个特征,Logistic回归分析示性别、CA19-9>27 kU/L、CA242>10 kU/L、形状(不规则)、胆管扩张、廓清时间<60 s、瘤内静脉、动脉期增强方式是预测ICC的独立危险因素(均P<0.05)。基于以上危险因素建立的列线图在训练集和验证集的ROC曲线下面积分别为0.963和0.914。训练集中该模型的特异度、敏感度分别为0.926、0.917,验证集中分别为0.875、0.871。校准曲线示模型的预测效果与实际情况的符合度良好。DCA曲线显示在多数合理阈值概率可以获得净收益。结论基于临床、常规超声及超声造影特征的列线图对术前鉴别ICC具有较好的预测价值,可为临床提供有价值的诊断依据。Objective To establish a nomogram for preoperative differentiating intrahepatic cholangiocarcinoma(ICC)from hepatocellular carcinoma(HCC)based on clinical,ultrasound,and contrast-enhanced ultrasound(CEUS)data.Methods A retrospective analysis was conducted on ultrasound and CEUS data of 462 patients who underwent hepatectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2023,including 262 cases of HCC(56.7%)and 200 cases of ICC(43.3%).The data were randomly divided into training set(n=324)and validation set(n=138)in a 7∶3 ratio.Univariate analysis was used to initially screen for variables with statistically significant differences between HCC and ICC groups in the training set,and LASSO regression was performed to select the variables with higher coefficients.Logistic regression analyses were then used to predict independent risk factors for ICC.A nomogram was drawn using R software.The performance of the nomogram was then validated using ROC curve,calibration curve,and decision curve analysis(DCA).Results Univariate analysis showed that there were significant differences in age,gender,liver cirrhosis,HBsAg(+),ALP>185 U/L,CA19-9>27 kU/L,CA242>10 kU/L,irregular shape,border,cholangiectasis,portal vein tumor thrombus,enhanced pattern in arterial phase,clearance time<60 s,intra-tumoral vein between ICC and HCC groups(all P<0.05).The top 10 features were selected for LASSO regression analysis.Logistic regression analysis revealed that gender,cirrhosis,CA19-9>27 kU/L,CA242>10 kU/L,cholangiectasis,clearance time<60 s,intra-tumoral vein and enhanced pattern in arterial phase were risk factors for ICC(all P<0.05).The area under the ROC curve in the training and validation groups were 0.963 and 0.914,respectively.In the training group,the specificity and sensitivity of the nomogram were 0.926 and 0.917,respectively,and in the validation group,they were 0.875 and 0.871,respectively.The calibration curve showed that the prediction effect of the mo

关 键 词：超声造影 超声检查 肝内胆管癌 肝细胞癌 列线图 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]