ALT/AST及影像学特征预测肝癌经动脉化疗栓塞患者的预后  

Application of serum AST/ALT ratio and imaging features in predicting the prognosis of patients with hepatocellular carcinoma after receiving transarterial chemoembolization

作　　者：李大伟 周振堰 周长友 张宁平 尚海龙[2] 王一超[2] LI Dawei;ZHOU Zhenyan;ZHOU Changyou;ZHANG Ningping;SHANG Hailong;WANG Yichao(Deparment of Radiology,Guangei Branch of the First Affiliated Hospital of Soochow Universily(Suzhou Guangci Cancer Hospital),Suzhou Jiangsu Province 215128,China)

机构地区：[1]苏州大学附属第一医院广慈分院(苏州广慈肿瘤医院)放射科,江苏苏州215128 [2]上海交通大学医学院苏州九龙医院

出　　处：《介入放射学杂志》2024年第8期849-854,共6页Journal of Interventional Radiology

基　　金：江苏省重点研发计划专项资金项目(BE2020695);吴中区科技计划项目(wzyw2021002)。

摘　　要：目的探讨经动脉化疗栓塞(transarterial chemoembolization,TACE)治疗前血清丙氨酸转氨酶/天冬氨酸转氨酶比值(ALT/AST)及影像学特征与肝癌患者预后的关系,构建预测患者总体生存率(overall survival,OS)的诺模图模型。方法纳入2016年7月至2020年7月苏州大学附属第一医院广慈分院诊断为肝癌并以TACE作为初始治疗的患者211例,将其随机分为建模组139例,验证组72例。采用受试者工作特征(receiver operation characteristics,ROC)曲线确定AST/ALT的最佳临界值。在建模组患者中进行单、多因素Cox回归分析,筛选影响肝癌患者OS的独立预测因素并构建预后模型。通过Harrell一致性指数(C指数)评价诺模图对肝癌患者OS的预测能力,校准曲线用于评估预后模型的预测准确性。结果建模组与验证组患者的基线特征分布差异均无统计学意义(均P>0.05)。两组患者中位OS分别为28.5个月(95%CI:22.1~34.9)和25.1个月(95%CI:19.2~29.0),差异无统计学意义(χ^(2)=1.395,P=0.322)。AST/ALT预测肝癌患者OS的最佳临界值为1.10,曲线下面积(area under curve,AUC)为0.674(95%CI:0.604~0.753)。Cox回归分析表明,肿瘤个数(HR=2.080,95%CI:1.245~3.475,P=0.005)、肿瘤包膜(HR=1.771,95%CI:1.128~2.780,P=0.013)、不规则边缘强化(HR=1.884,95%CI:1.190~2.984,P=0.007)和AST/ALT(HR=2.450,95%CI:1.506~3.987,P<0.01)是接受TACE治疗肝癌患者的独立预后因素。基于以上变量构建预测OS的诺模图模型,其在建模组与验证组中的C指数分别为0.733(95%CI:0.650~0.826)和0.770(95%CI:0.688~0.862)。校准曲线显示预后模型对1、2和3年OS的预测曲线与理想参考线之间未见明显偏离。结论基于肿瘤个数、影像学特征及AST/ALT的诺模图对接受TACE治疗的肝癌患者预后显示了良好的预测价值。Objective To explore the relationship of the preoperative serum alanine aminotransferase(ALT)/aspartate aminotransferase(AST)ratio and imaging features to the prognosis of patients with hepatocellular carcinoma(HCC)after receiving transarterial chemoembolization(TACE),and to develop a nomogram model used for predicting the patient's overall survival(OS).Methods A total of 211 patients,who were diagnosed as HCC and were treated with TACE as the initial therapy at the Guangci Branch of the First Affiliated Hospital of Soochow University of China between July 2016 and July 2020,were enrolled in this study.The patients were randomly divided into the modeling group(n=139)and validation group(n=72).The receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of AST/ALT ratio.The univariate and multivariate Cox regression analyses were conducted in the modeling group to screen out the independent predictors affecting HCC patient's OS and to establish a prognostic model.Harrell consistency index(C-index)was used to evaluate the predictive ability of the nomogram model for OS in HCC patients,and the calibration curves were plotted to assess the predictive accuracy of the nomogram model.Results No statistically significant difference in the baseline feature distribution existed between the modeling group and validation group(P>0.05).The median OS of the modeling group and validation group was 28.5 months(95%CI:22.1-34.9)and 25.1 months(95%CI:19.2-29.0)respectively,the difference was not statistically significant(χ^(2)=1.395,P=0.322).The optimal cutoff value of AST/ALT ratio for predicting OS was 1.10,and the area under curve(AUC)value was 0.674(95%CI:0.604-0.753).The Cox regression analysis indicated that the tumor number(HR=2.080,95%CI=1.245-3.475,P=0.005),tumor capsule(HR=1.771,95%CI=1.128-2.780,P=0.013),irregular marginal enhancement(HR=1.884,95%CI=1.190-2.984,P=0.007),and AST/ALT ratio(HR=2.450,95%CI=1.506-3.987,P<0.01)were the independent prognostic factors for HCC patients receiving

关 键 词：肝癌 经动脉化疗栓塞 丙氨酸氨基转移酶/天冬氨酸氨基转移酶比值 预后 诺模图 

分 类 号：R753.7[医药卫生—皮肤病学与性病学]