肝细胞癌TACE术后复发影响因素及预测模型建立  

Influencing factors and prediction model for recurrence of hepatocellular carcinoma after TACE

作　　者：公宇 廖媛[2] 尚梅 Gong Yu;Liao Yuan;Shang Mei(Department of Endoscopy,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Clinical Laboratory,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学肿瘤防治中心内镜科,广州510060 [2]中山大学附属第三医院检验科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期818-824,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省基础与应用基础研究联合基金(2020A1515110152)

摘　　要：目的探讨肝细胞癌(肝癌)患者TACE术后1年内复发的危险因素,并构建列线图预测模型。方法回顾性分析2021年8月至2022年8月在中山大学附属第三医院首次行TACE的85例肝癌初诊患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男78例,女7例;平均年龄(58±12)岁。肝癌CNLC分期Ⅰb期22例,Ⅱa期12例,Ⅱb期24例,Ⅲa期9例,Ⅲb期18例;肿瘤直径1.5~19.2 cm,中位直径6.0 cm;多发49例,单发36例。按TACE术后短期复发状态分为短期预后良好组和短期预后不良组,收集两组一般临床资料及检验指标等相关资料,Cox回归分析短期预后影响因素,采用R语言构建列线图模型。绘制校准曲线,同时进行模型内部验证。采用ROC曲线下面积(AUC)评估该模型的预测价值,使用决策曲线分析(DCA)评估该模型的临床价值。结果Cox单因素回归分析显示,AFP(HR=5.055,95%CI:2.224~11.490)、肝硬化(HR=6.261,95%CI:1.862~21.060)、IL-6差值(HR=0.409,95%CI:0.171~0.979)和C-反应蛋白(CRP)差值(HR=2.905,95%CI:1.158~7.287)与TACE术后短期复发有关(P<0.05);Cox多因素回归分析显示,AFP≥400μg/L(HR=3.722,95%CI:1.543~8.978)、肝硬化(HR=4.406,95%CI:1.249~15.548),IL-6差值≥18.79 pg/ml(HR=0.312,95%CI:0.119~0.819),CRP差值≥36.67 mg/L(HR=4.967,95%CI:1.895~13.021)是TACE术后短期复发的独立危险因素(P<0.05)。基于独立危险因素绘制列线图模型,模型内部验证显示预测TACE术后复发的一致性指数(C-index)为0.875(95%CI:0.842~0.907),分辨度良好;ROC曲线分析该模型预测术后1年无复发生存的AUC为0.794,DCA评估该模型的临床价值,提示该模型的净获益值大,临床价值比较高。结论AFP、肝硬化、IL-6差值和CRP差值是TACE治疗的肝癌患者术后短期复发的独立危险因素,以此为指标成功构建了预测TACE术后复发的列线图模型,该模型在预判肝癌患者复发情况具有一定的实用价值。Objective To investigate the risk factors of recurrence in patients with hepatocellular carcinoma(HCC)within 1 year after TACE,and establish a nomogram prediction model.Methods Clinical data of 85 patients newly diagnosed with HCC who underwent transarterial chemoembolization(TACE)for the first time in the Third Affiliated Hospital of Sun Yat-sen University from August 2021 to August 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,78 patients were male and 7 female,aged(58±12)years on average.According to the China liver cancer(CNLC)staging system,22 patients were classified as CNLC stageⅠb,12 cases of stageⅡa,24 cases of stageⅡb,9 cases of stageⅢa and 18 cases of stageⅢb,respectively.The tumor diameter was ranged from 1.5 to 19.2 cm,with a median diameter of 6.0 cm.49 cases had multiple tumors and 36 cases with single tumor.According to patients'situation of short-term recurrence after TACE,all patients were divided into the favorable and poor prognosis groups.Clinical data and detection parameters in two groups were collected.Cox's regression model was used to analyze the influencing factors of short-term prognosis,and R language was adopted to establish the nomograph model.The calibration curve was delineated and internal validation of the prediction model was performed.The area under the receiver operating characteristic(ROC)curve(AUC)was employed to evaluate the predictive value of this model.Decision curve analysis(DCA)was adopted to evaluate the clinical value of this model.Results Univariate Cox's regression analysis showed that AFP(HR=5.055,95%CI:2.224-11.490),liver cirrhosis(HR=6.261,95%CI:1.862-21.060)and differences of IL-6 levels(HR=0.409,95%CI:0.171-0.979)and differences of C-reactive protein(CRP)levels(HR=2.905,95%CI:1.158-7.287)were correlated with short-term recurrence after TACE(P<0.05).Multiple Cox's regression analysis showed that AFP≥400μg/L(HR=3.722,95%CI:1.543-8.978),liver c

关 键 词：癌 肝细胞 化学栓塞 治疗性 复发 影响因素 生存分析 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]