肝癌患者经导管动脉化疗栓塞术后肝功能不全发生风险列线图预测模型的构建及验证  

Construction and validation of a nomogram prediction model for the risk of liver dysfunction in liver cancer patients after transcatheter arterial chemoembolization

作　　者：夏国盛 李勤 钟佳 刘路 黄道斌 XIA Guosheng;LI Qin;ZHONG Jia;LIU Lu;HUANG Daobin(Department of Gastroenterology,Ji’an Central People’s Hospital,Ji’an 343000,Jiangxi,China)

机构地区：[1]吉安市中心人民医院消化内科,江西吉安3430000

出　　处：《癌症进展》2024年第18期2056-2060,共5页Oncology Progress

基　　金：江西省卫生健康委科技计划项目(202310099)。

摘　　要：目的构建并验证肝癌患者经导管动脉化疗栓塞术后肝功能不全发生风险的列线图预测模型。方法选取46例肝癌TACE术后发生肝功能不全患者(纳入肝功能不全组)和46例肝癌TACE术后未发生肝功能不全患者(纳入肝功能正常组)。肝癌患者TACE术后肝功能不全的影响因素采用多因素Logistic回归模型分析,依据影响因素构建肝癌患者TACE术后肝功能不全的列线图预测模型。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估列线图预测模型对肝癌患者TACE术后肝功能不全的预测价值。采用内部校正曲线评估列线图预测模型的准确性,采用决策曲线评估列线图预测模型的外部一致性。结果多因素Logistic回归分析结果显示,肝癌类型为巨块型、合并肝硬化、吲哚氰绿15 min潴留率(ICGR15)﹥10%、Child-Pugh分级为B级、白蛋白-胆红素(ALBI)﹥-1.39均为肝癌患者TACE术后肝功能不全的独立危险因素(P﹤0.05)。构建的列线图模型预测肝癌患者TACE术后肝功能不全的AUC为0.755(95%CI:0.633~0.876),预测价值中等。校正曲线显示,列线图预测模型对肝癌患者TACE术后肝功能不全具有较高的准确度。决策曲线显示,列线图预测模型预测肝癌患者TACE术后肝功能不全的临床净获益较好。结论肝癌类型为巨块型、合并肝硬化、ICGR15﹥10%、Child-Pugh分级为B级、ALBI﹥-1.39均为肝癌患者TACE术后肝功能不全的独立危险因素,构建的列线图预测模型可指导临床量化评估肝癌患者TACE术后肝功能不全的发生风险,具有较高的临床应用价值。Objective To construct and validate a nomogram prediction model for the risk of liver dysfunction in liver cancer patients after transcatheter arterial chemoembolization(TACE).Method A total of 46 liver cancer patients with liver dysfunction after TACE(included in the liver dysfunction group)and 46 liver cancer patients without liver dysfunction after TACE(included in the normal liver function group)were selected.The influencing factors of postoperative liver dysfunction in liver cancer patients after TACE were analyzed by multivariate Logistic regression model,and a nomogram prediction model for liver dysfunction in liver cancer patients after TACE was constructed based on the influencing factors.The receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated,and the predictive value of nomogram prediction model for postoperative liver dysfunction in liver cancer patients after TACE was evaluated.The internal calibration curve was used to evaluate the accuracy of the nomogram prediction model,and the decision curve was used to evaluate the external consistency of the nomogram prediction model.Result Multivariate Logistic regression analysis showed that the type of massive liver cancer,concomitant cirrhosis,indocyanine green retention rate at 15 min(ICGR15)>10%,Child-Pugh grade B,and albumin-bilirubin(ALBI)>-1.39 were independent risk factors for postoperative liver dysfunction in liver cancer patients after TACE(P<0.05).The nomogram prediction model has a moderate predictive value for postoperative liver dysfunction in liver cancer patients after TACE,the AUC was 0.755(95%CI:0.633-0.876).The calibration curve showed that the nomogram prediction model has high predictive accuracy for postoperative liver dysfunction in liver cancer patients after TACE.The decision curve showed that the nomogram prediction model has better clinical net benefit in predicting postoperative liver dysfunction in liver cancer patients after TACE.Conclusion The type of massive liver cancer,concomitan

关 键 词：肝癌 经导管动脉化疗栓塞 肝功能不全 列线图预测模型 

分 类 号：R735.7[医药卫生—肿瘤]