无法实施根治性手术治疗的晚期HCC患者肝动脉灌注化疗后0.5、1、2年预后预测列线图构建及评价  

Construction and evaluation of 0.5-,1-,and 2-year prognosis prediction nomogram of advanced HCC patients who can not be treated with radical surgery after HAIC

作　　者：王希 杨洪吉 WANG Xi;YANG Hongji(School of Medicine,University of Electronic Science and Technology of China,Chengdu 610053,China)

机构地区：[1]电子科技大学医学院,成都610053 [2]四川省医学科学院‧四川省人民医院器官移植中心

出　　处：《山东医药》2024年第21期1-5,共5页Shandong Medical Journal

摘　　要：目的构建无法实施根治性手术治疗的晚期肝细胞癌(HCC)患者肝动脉灌注化疗(HAIC)后0.5、1、2年预后预测列线图,并进行验证评价。方法接受HAIC的无法实施根治性手术治疗的HCC患者124例,按照6∶4被随机分为训练组和验证组,训练组74例用于构建列线图,并进行内部验证,验证组50例用于外部验证。采用单因素COX回归模型进行生存分析,纳入因素包括年龄、性别、ECOG评分、影像学可见的肝硬化、肿瘤大小、肿瘤数量、是否具有门脉癌栓、是否有肝外转移以及Child-Pugh分级、甲胎蛋白(AFP)、AST、ALT、Alb、TBIL、CRP、HBV等,初步筛选接受HAIC的无法实施根治性手术治疗的HCC患者预后影响因素。然后进行多因素COX回归分析,获得接受HAIC的无法实施根治性手术治疗的HCC患者预后独立影响因素,并基于队列中的COX模型参数估计值构建接受HAIC的无法实施根治性手术治疗的HCC患者0.5、1、2年预后预测列线图。采用区分度和校准度来评估列线图模型的预测效果。通过分析受试者工作特征(ROC)曲线的曲线下面积(AUC)评估预测列线图的区分度,采用校准曲线评估列线图模型预测的校准度。结果肿瘤大小、AFP、癌栓、CRP等4个因素是接受HAIC的无法实施根治性手术治疗的HCC患者预后独立影响因素,并成功构建接受HAIC的无法实施根治性手术治疗的HCC患者0.5、1、2年预后预测列线图。ROC分析结果显示,构建的列线图模型预测训练组接受HAIC的无法实施根治性手术治疗的HCC患者的0.5、1、2年总生存率的AUC值均大于0.70,说明构建的列线图具有良好的区分度。校准曲线显示构建的列线图预测概率与实际结果之间具有良好的一致性。结论成功构建了由肿瘤大小、AFP、癌栓、CRP等4个预后独立影响因素组成的接受HAIC的无法实施根治性手术治疗的HCC患者0.5、1、2年预后预测列线图,验证评价效果较好。Objective To construct the 0.5-,1-,and 2-year prognosis prediction nomogram of advanced hepatocel‑lular carcinoma(HCC)patients who can not be treated with radical surgery after hepatic arterial infusion chemotherapy(HAIC)and to conduct the verification and evaluation.Methods Totally124 HCC patients who received HAIC and could not be treated with radical surgery were randomly divided into the training group and validation group according to 6:4.Seventy-four cases in the training group were used to construct the nomogram and to conduct internal validation,and 50 cases in the validation group were used for external verification.Univariate COX analysis was used for survival analysis.The factors included age,sex,Eastern Cooperative Oncology Group(ECOG)score,cirrhosis visible on imaging,tumor size,tumor number,presence of portal cancer thrombin,presence of extrahepatic metastasis,Child-Pugh grade,Alpha fe‑toprotein(AFP),aspartate transaminase(AST),alanine aminotransferase(ALT),albumin(Alb),total bilirubin(TBIL),C-reactive protein(CRP),hepatitis B virus(HBV),etc.The prognostic factors of HCC patients receiving HAIC who could not be treated with radical surgery were preliminarily screened.Multivariate COX analysis was then performed to obtain independent prognostic factors for HCC patients who received HAIC and could not be treated with radical sur‑gery.Based on the estimated values of COX model parameters in the cohort,the 0.5-,1-,and 2-year prognostic nomo‑grams of these patients were constructed.The differentiation and calibration were used to evaluate the prediction effect of the nomogram model.The differentiation of the prediction nomogram was evaluated by analyzing the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Calibration curves were used to evaluate the degree of cali‑bration of the nomogram model.Results Four factors,including tumor size,AFP,cancer embolus,and CRP were inde‑pendent prognostic factors for HCC patients who received HAIC and could not be treated with rad

关 键 词：化学疗法 肝动脉灌注化疗 肝细胞癌 列线图 预后预测列线图 

分 类 号：R735.7[医药卫生—肿瘤]