肝细胞癌术后早期复发风险的循证预测模型及外部验证研究  

An evidence-based predictive model for early recurrence risk after hepatocellular carcinoma surgery and external validation study

作　　者：周文考 赵方俐 陈嘉佳 陈磊 黄灵炎 王越[1] 唐慧敏 Zhou Wenkao;Zhao Fangli;Chen Jiajia;Chen Lei;Huang Lingyan;Wang Yue;Tang Huimin(Department of General Surgery,Liaoning Cancer Hospital,Shenyang 110000,China;Department of Emergency,Xiang'An Hospital of Xiamen University,Xiamen 361000,China)

机构地区：[1]辽宁省肿瘤医院普通外科,沈阳110000 [2]厦门大学附属翔安医院急诊科,厦门361000

出　　处：《肿瘤研究与临床》2024年第11期835-842,共8页Cancer Research and Clinic

摘　　要：目的基于Meta分析构建肝细胞癌(HCC)术后早期复发循证预测模型, 并进行外部验证。方法依据主题词检索中国知网、万方、维普、中国科学引文数据库(CSCD)、中文社会科学引文索引(CCSCI)、PubMed、Web of Science和IEEE等数据库2019年1月至2023年12月的文献, 根据纳入、排除标准, 纳入9篇文献, 筛选影响HCC早期复发的危险因素;同一危险因素在≥5篇文献中出现时, 采用Review Manager 5.4.1软件进行Meta分析。外部验证数据来源于2014年3月至2017年3月在辽宁省肿瘤医院进行手术的401例原发性HCC患者, 根据患者术后2年是否复发分为早期复发组(176例)和未早期复发组(225例);将Meta分析获得的各危险因素的OR值进行转换建模, 以Meta分析中HCC术后早期复发率计算β0, 最终得出logistic模型;将OR值纳入logit(P)模型, 计算外部验证数据的发病率(P), 以术后2年是否复发为因变量, P为自变量, 绘制受试者工作特征(ROC)曲线, 并计算曲线下面积(AUC)。结果以9篇文献中筛选出8个HCC早期复发的危险因素(x1:甲胎蛋白≥400 ng/ml;x2:肿瘤数目≥2个;x3:肿瘤最大径≥5 cm;x4:巴塞罗那分期B~C期;x5:微血管侵犯;x6:中低分化;x7:包膜不完整;x8:非解剖型肝切除)。Meta分析纳入HCC患者1 757例, 其中术后早期复发960例, 早期复发率为45.36%, 得出β0=-0.201;构建HCC术后2年复发的预测模型, logit(P)=-0.201+0.835x1+0.905x2+0.783x3+1.008x4+0.765x5+0.831x6+1.533x7+0.940x8。外部验证数据差异性分析结果显示, 早期复发组和未早期复发组腹腔积液、甲胎蛋白、肿瘤数目、肿瘤长径、巴塞罗那分期、微血管侵犯、肿瘤分化程度、包膜侵犯、切除类型和系统性炎症指数比较, 差异均有统计学意义(均P<0.05)。ROC曲线显示, 模型预测HCC术后早期复发AUC为0.718(95%CI:0.689~0.753), 最佳临界值为3.11, 约登指数为0.288, 灵敏度为69.32%, 特异度为69.56%。结论基于Meta分析构建Objective:To construct an evidence-based prediction model for early recurrence after surgery of hepatocellular carcinoma(HCC)based on Meta-analysis and to do external validation study.Methods:The literatures in Chinese National Knowledge Infrastructure,Wanfang,VIP,Chinese Science Citation Database(CSCD),Chinese Social Science Citation System(CCSCI),PubMed,Web of Science and IEEE databases between January 2019 and December 2023 were searched based on the subject words.According to the inclusion and exclusion criteria,9 literatures were included to screen the risk factors affecting the early recurrence of HCC.When the same risk factor was found in≥5 included literatures,Meta-analysis was performed by using Review Manager 5.4.1 software.External validation data were collected from 401 patients with primary HCC who underwent surgery in Liaoning Cancer Hospital between March 2014 and March 2017.The patients were divided into early recurrence group(176 cases)and early non-recurrence group(225 cases)according to whether they relapsed 2 years after surgery.The OR values of all risk factors obtained in the Meta-analysis were converted into modeling,and postoperative early recurrence rate of HCC in the Meta-analysis was used to calculateβ0,and finally the logistic model was obtained.The OR value was incorporated into the logit(P)model,and the morbidity(P)of the external validation data was calculated.Taking the recurrence 2 years after surgery or not as the dependent variable and P as the independent variable,the receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve(AUC).Results:A total of 8 risk factors for early HCC recurrence were screened out from 9 literatures(x 1:alpha-fetoprotein≥400 ng/ml;x 2:tumor number≥2;x 3:the longest tumor diameter≥5 cm;x 4:Barcelona staging B-C;x 5:microvascular invasion;x 6:moderate to low differentiation;x 7:incomplete capsule;x 8:nonanatomic hepatectomy).The Meta-analysis included 1757 HCC cases,with 960 postoperative early recurrences and an

关 键 词：癌 肝细胞 复发 荟萃分析 预测模型 外部验证 

分 类 号：R735.7[医药卫生—肿瘤]