基于MRI影像及临床参数的列线图预测肝细胞癌D-TACE疗效的双中心研究  

A two-center study of MRI and clinical parameter-based nomogram for predicting the efficacy of D-TACE in hepatocellular carcinoma

作　　者：王洁雨 隰子涵 田宇驰 杨永波[3] 裘华锋 曾晖[5] 梁晓云 江海涛 WANG Jieyu;XI Zihan;TIAN Yuchi;YANG Yongbo;QIU Huafeng;ZENG Hui;LIANG Xiaoyun;JIANG Haitao(Postgraduate Training Base Alliance of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;不详)

机构地区：[1]温州医科大学研究生培养基地,浙江温州325000 [2]东软医疗系统股份有限公司-东软医疗创新研究院,上海200000 [3]浙江省肿瘤医院放射科,浙江杭州310022 [4]嵊州市人民医院放射科,浙江嵊州312400 [5]浙江省肿瘤医院介入治疗科

出　　处：《中华全科医学》2024年第11期1827-1832,1916,共7页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2023KY598,2021KY567)。

摘　　要：目的探究术前基线增强MRI的影像学特征、临床相关因素对药物洗脱微球-经导管肝动脉化疗栓塞术(D-TACE)疗效的影响。方法回顾性分析浙江省肿瘤医院(2018年10月—2022年5月)和嵊州市人民医院(2016年8月—2021年3月)接受初始治疗为D-TACE的患者145例,根据改良实体瘤疗效评价标准(mRECIST)评估D-TACE后的肿瘤应答,应用单因素及多因素logistic回归方法筛选出与D-TACE短期疗效相关的独立因素并建立列线图,并通过绘制ROC曲线,计算AUC。通过多因素Cox回归分析确定影响无进展生存期(PFS)的相关因素。结果研究纳入145例患者,多因素logistic回归分析显示谷氨酰转移酶(GGT)、肿瘤肝脏体积比、载药量、门脉癌栓与D-TACE后的短期疗效显著相关;经Bootstrap法进行内部验证,构建的列线图AUC值为0.796(95%CI:0.719~0.864);校准曲线显示,模型预测值和实际值具有良好的一致性,表明模型的预测性能良好;临床决策曲线显示列线图在临床应用方面表现良好。多因素Cox回归分析显示性别、术后短期疗效是影响PFS的相关因素。结论增强MRI的影像学资料和临床相关参数构建的列线图对首次D-TACE短期疗效具有较好的预测效果,有望为筛选从D-TACE中获益的患者提供一种方法。女性、术后短期疗效达到完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)的患者具有更长的PFS。Objective To investigate the effects of preoperative imaging features on baseline contrast-enhanced MRI,as well as clinically relevant factors on the efficacy of drug-eluting bead transarterial chemoembolization(D-TACE).Methods A retrospective analysis of patients from two centers who received D-TACE as initial therapy was conducted,with the objective of assessing tumour response after D-TACE according to the modified response tumour evaluation criteria in solid tumours.The objective was to identify the independent factors related to the short-term outcomes of D-TACE.This was achieved by applying univariate and multivariate logistic regression methods,and a nomogram was established.The area under the curve(AUC)was calculated by plotting the receiver operating characteristic(ROC).The factors associated with PFS were determined by means of a multivariate Cox regression analysis.Results The study cohort comprised 145 patients.The results of the multivariate logistic regression analysis indicated that GGT,tumour-to-liver volume ratio,drug-loaded status,and portal vein tumour thrombus was significantly associated with short-term outcomes following D-TACE.Following internal validation by the bootstrap method,the area under the curve(AUC)value of the constructed nomogram was 0.796(95%CI:0.719-0.864).The calibration curves demonstrate a high degree of concordance between the predicted and actual values of the model,which indicates an excellent predictive performance.The decision curve analysis indicates that the nomogram performs well in clinical applications.Multivariate Cox regression analysis revealed that gender and postoperative short-term outcomes were significant factors affecting PFS.Conclusion The nomogram,constructed from contrast-enhanced MRI imaging features and clinically relevant parameters,has been demonstrated to be an effective predictor of first D-TACE short-term outcomes.It is anticipated that this nomogram will facilitate the identification of patients who are likely to benefit from D-TACE.Female pati

关 键 词：肝细胞癌 药物洗脱微球-经导管肝动脉化疗栓塞术 磁共振成像 无进展生存期 列线图 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]