肝细胞癌射频消融术后局部肿瘤进展风险预测  

Predicting the risk of local tumor progression after radiofrequency ablation of hepatocellular carcinoma

作　　者：王红芳 杨冠华 王明磊[1] 白玉 陈勇[2] WANG Hongfang;YANG Guanhua;WANG Minglei;BAI Yu;CHEN Yong(the First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Interventional Radiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学第一临床医学院,宁夏银川750004 [2]宁夏医科大学总医院放射介入科,宁夏银川750004

出　　处：《实用放射学杂志》2024年第11期1875-1879,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(62261044);宁夏自治区重点研发计划项目(2018BFH03021)。

摘　　要：目的探讨肝细胞癌(HCC)患者经射频消融(RFA)术后发生局部肿瘤进展(LTP)的危险因素并构建预测模型。方法回顾性分析经RFA治疗的122例HCC患者的临床资料,根据术后12个月内是否发生LTP分为LTP阳性组和LTP阴性组。采用单因素和多因素分析确定发生LTP的危险因素,构建预测模型并进行内部验证。结果本研究结果显示肿瘤多发、肿瘤直径>2 cm、肿瘤边缘毛糙和肿瘤位于大血管旁可作为LTP的独立预测因素,纳入以上因素构建预测模型。内部验证结果显示,其受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.815[95%置信区间(CI)0.735~0.895],提示模型具有较高的区分度;绘制校准曲线并经Hosmer-Lemeshow拟合优度检验,提示模型具有良好的稳定性(P>0.05);决策曲线提示模型具有较好的临床应用价值。结论肿瘤多发、肿瘤直径>2 cm、肿瘤边缘毛糙、肿瘤位于大血管旁是HCC经RFA术后发生LTP的独立危险因素,基于以上因素构建的预测模型可用于评估肿瘤局部复发风险,为制订治疗方案及随访策略提供参考依据。Objective To investigate the risk factors for identifying local tumor progression(LTP)in patients with hepatocellular carcinoma(HCC)after radiofrequency ablation(RFA)and to establish a predictive model.Methods The clinical data of 122 HCC patients treated by RFA were analyzed retrospectively,and then the patients were divided into positive and negative LTP groups according to that whether LTP occurred within 12 months after RFA.The risk factors of LTP were determined using univariate and multivariate analysis,and the predictive model was constructed based on these factors and the internal validation was conducted.Results The results of this study showed that multiple number,diameter>2 cm,rough margin,and adjacent to large blood vessels of the tumor could be independent predictors of LTP,which were further incorporated into constructing the predictive model.Internal validation results showed that the area under the curve(AUC)of receiver operating characteristic(ROC)curve was 0.815[95%confidence interval(CI)0.735-0.895],indicating the model with high differentiation ability.The calibration curve was drawn and the Hosmer-Lemeshow goodness-fit test showed that the model had good stability(P>0.05).The decision curve suggested that the model had good clinical application value.Conclusion The independent risk factors of LTP of HCC after RFA are multiple number,diameter>2 cm,rough margin,and adjacent to large blood vessels of the tumor.When the predictive model is integrated with the above factors,it can potentially predict the risk of local tumor and may offer useful guidance for individual treatment and follow-up.

关 键 词：肝细胞癌 射频消融 局部肿瘤进展 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]