初始不可切除肝细胞癌降期后行肝切除术患者早期复发影响因素分析及预测模型构建的多中心研究  

Analysis of factors influencing early recurrence for patients with initially unresectable hepatocellular carcinoma who underwent liver resection following downstaging treatment and construction of a predictive model:a multicenter study

作　　者：杨云 卢鹏 林孔英 党政 郭威 潘泽亚 周伟平 Yang Yun;Lu Peng;Lin Kongying;Dang Zheng;Guo Wei;Pan Zeya;Zhou Weiping(The Third Department of Hepatic Surgery,Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital),Shanghai 200438,China;Department of Hepatobiliary Surgery,Hainan Hospital of Chinese PLA General Hospital,Sanya 572000,China;Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350001,China;Department of Hepatobiliary Surgery,940 Hospital of PLA Joint Logistic Support Force,Lanzhou 730050,China;Department of Health Statistics,Navy Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第三附属医院(上海东方肝胆外科医院)肝外三科,上海200438 [2]中国人民解放军总医院海南医院肝胆外科,三亚572000 [3]福建医科大学孟超肝胆医院肝胆外科,福州350001 [4]联勤保障部队940医院肝胆外科,兰州730050 [5]海军军医大学卫生统计学教研室,上海200433

出　　处：《中华消化外科杂志》2025年第2期223-235,共13页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82073031)。

摘　　要：目的探讨以经导管动脉化疗栓塞术为基础的降期治疗后初始不可切除肝细胞癌患者行挽救性肝切除术后早期复发影响因素,构建其预测模型并评估预测效能。方法采用回顾性队列研究方法。收集2019年1月至2021年12月海军军医大学第三附属医院(上海东方肝胆外科医院)等全国4家医院收治的305例初始不可切除肝细胞癌患者临床病理资料;男286例,女19例;年龄为(48.7±10.4)岁。2019年1月至2020年12月收治的133例患者为训练集;2021年1―12月收治的172例患者为验证集。观察指标:(1)肝细胞癌患者术后无复发生存情况。(2)肝细胞癌患者术后早期复发的影响因素分析。(3)预测模型的构建和效能评价。正态分布的计量资料组间比较采用独立样本t检验。计数资料组间比较采用χ²检验。等级资料组间比较采用秩和检验。采用Cox回归模型进行单因素和多因素分析。采用Kaplan‑Meier法计算生存率,Log‑rank检验进行生存分析。采用一致性指数(C‑index)、时间依赖性受试者工作特征曲线下面积评价模型的预测效能;校准曲线评估模型的准确性;决策曲线评估模型的总体净收益。结果(1)肝细胞癌患者术后无复发生存情况。133例训练集肝细胞癌患者无复发生存时间为10.0(1.5~24.0)个月,1、2年无复发生存率分别为47.3%、36.8%。172例验证集患者无复发生存时间为11.0(1.0~24.0)个月,1、2年无复发生存率分别为51.7%、37.2%。两组患者无复发生存情况比较,差异无统计学意义(χ²=0.075,P>0.05)。(2)肝细胞癌患者术后早期复发的影响因素分析。多因素分析结果显示:降期治疗前肿瘤负荷,挽救性肝切除术前白蛋白‑胆红素评分分级、甲胎蛋白半衰期、肿瘤反应均是肝细胞癌患者术后早期复发的独立影响因素[风险比=3.212、2.526、2.304、1.575,95%可信区间(CI)为1.262~8.175、1.324~4.818、1.477~3.595、1.138~2.180,P<0.05]。(3)预�Objective To investigate the factors influencing early recurrence for patients with initially unresectable hepatocellular carcinoma(HCC)who underwent salvage liver resection(SLR)following transcatheter arterial chemoembolization‐based downstaging treatment,and construct a predictive model to evaluate its predicting performance.Methods The retrospective cohort study was constructed.The clinicopathological data of 305 patients with initially unresectable HCC who were admitted to 4 medical centers in China,including the Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital)et al,from January 2019 to December 2021 were collected.There were 286 males and 19 females,aged(48.7±10.4)years.A total of 133 patients who were admitted from January 2019 to December 2020 were set as the training cohort,and the other 172 patients who were admitted from January to December 2021 were set as the validation cohort.Observation indicators:(1)postoperative recurrence‐free survival in HCC patients;(2)analysis of factors influencing postoperative early recurrence in HCC patients;(3)construction and validation of the predictive model.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test.Comparison of count data between groups was conducted using the chi‐square test.Comparison of ordinal data was conducted using the rank sum test.Univariate and multivariate analyses were conducted using the Cox regression model.The Kaplan‐Meier method was used to calculate survival.The Log‐rank test was used for survival analysis.The predicting performance of the model was evaluated using the concordance index(C‐index)and the area under curve(AUC)of time‐dependent receiver operating characteristic(ROC)curve,and the accuracy of the model was validated using the calibration curve.The total net gain of the model was evaluated using the decision curve.Results(1)Postoperative recurrencefree survival in HCC patients.The recurrence-fre

关 键 词：肝肿瘤 列线图 降期治疗 挽救性肝切除 早期复发 

分 类 号：R73[医药卫生—肿瘤]