BCLC 0/A期肝细胞癌患者术后辅助治疗后早期复发风险分析及预测模型建立  

Risk analysis and prediction model establishment of early recurrence in patients with BCLC stage 0/A hepatocellular carcinoma after postoperative adjuvant therapy

作　　者：韦洋 赵远权 王小波[3] 黄海 陈洁[3] Wei Yang;Zhao Yuanquan;Wang Xiaobo;Huang Hai;Chen Jie(Department of Hepatobiliary Surgery,Wuming Hospital,Guangxi Medical University,Nanning Guangxi Zhuang Autonomous Region 530100,China;Department of Hepatobiliary Surgery,Guangxi Autonomous People's Hospital,Nanning Guangxi Zhuang Autonomous Region 530100,China;Department of Hepatopancreatic Surgery,Affiliated Cancer Hospital of Guangxi Medical University,Nanning Guangxi Zhuang Autonomous Region 530100,China)

机构地区：[1]广西医科大学附属武鸣医院肝胆外科,南宁530100 [2]广西壮族自治区人民医院肝胆外科,南宁530100 [3]广西医科大学附属肿瘤医院肝脏胰腺外科,南宁530100

出　　处：《中华普外科手术学杂志(电子版)》2025年第2期157-161,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金(81860512)。

摘　　要：目的分析肝切除术后辅助经动脉化疗栓塞(PA-TACE)或肝切除术后辅助放疗(PA-RT)的巴塞罗那分期(BCLC)早期肝癌(HCC)患者的复发风险,并构建预测模型。方法回顾性分析2013年11月至2018年3月接受肝切除术及术后辅助PA-TACE或PA-RT治疗的HCC患者202例作为模型组构建预后评分系统。以2018年3月至2018年12月接受肝切除术及术后辅助PA-TACE或PA-RT治疗的50例HCC患者作为验证组对构建的评分系统进行验证。使用SPSS 23.0版软件进行统计分析。定性资料比较采用χ^(2)检验或者Fisher确切概率法检验;定量资料采用t检验,通过受试者工作特征(ROC)曲线分析确定模型的最佳截断值;使用Kaplan-Meier方法计算生存结果,并使用Log-Rank检验进行比较组间差异;采用Logistic回归来确定独立预测早期复发的危险因素。P<0.05为差异有统计学意义。结果微血管浸润(MVI)、Edmondson分级、HBV-DNA水平、肿瘤直径是早期复发的独立危险因素。并且以独立危险因素构建评分系统,以2.177分为分界点,将患者分为高评分组(>2.177分)和低分组(≤2.177分)。高评分组患者出现早期复发的可能性显著高于对照组(P<0.05)。结论基于MVI、Edmondson分级、HBV-DNA水平和肿瘤直径评分系统可以预测PA-TACE或PA-RT治疗的早期HCC患者的早期复发。PA-TACE和PA-RT对评分较低(≤2.177分)的早期HCC患者可能有帮助。Objective To analyze the risk of recurrence in Barcelona Stage(BCLC)patients with early liver cancer(HCC)after hepatectomy with adjuvant transarterial chemoembolization(PA-TACE)or adjuvant radiotherapy after hepatectomy with radiotherapy(PA-RT),and to construct predictive models.Methods A retrospective analysis of 202 HCC patients who underwent hepatectomy and postoperative adjuvant PA-TACE or PA-RT from November 2013 to March 2018 was performed to establish a prognostic scoring system as a model group.Fifty HCC patients who underwent hepatectomy and postoperative adjuvant PA-TACE or PA-RT from March 2018 to December 2018 were used as the validation group to verify the constructed scoring system.SPSS 23.0 software was used for statistical analysis.Qualitative data were compared byχ^(2)test or Fisher exact probability test.The optimal cut-off value of the model was determined by receiver operating characteristic(ROC)curve analysis using t test for quantitative data.Kaplan-Meier method was used to calculate survival results,and Log-Rank test was used to compare differences between groups.Logistic regression was used to identify risk factors that independently predicted early recurrence.P<0.05 was considered statistically significant.Results Microvascular invasion(MVI),Edmondson grade,HBV-DNA level,and tumor diameter were independent risk factors for early recurrence.A scoring system was constructed based on independent risk factors,and 2.177 was used to divide the patients into high rating groups(>2.177 points)and low rating groups(≤2.177 points).The probability of early recurrence in high rating group was significantly higher than that in control group(P<0.05).Conclusion MVI,Edmondson grading,HBV-DNA levels,and tumor diameter scoring systems can predict early recurrence in early HCC patients treated with PA-TACE or PA-RT.PA-TACE and PA-RT may be helpful for patients with early HCC with low scores(≤2.177).

关 键 词：癌 肝细胞 肝切除术 复发 预后 

分 类 号：R73[医药卫生—肿瘤]