原发性肝癌自发性破裂的预测模型构建

Establishment of prediction model for spontaneous rupture of primary liver cancer

目的：构建评估原发性肝癌自发性破裂风险的方法。方法：回顾性分析浙江大学医学院附属第一医院2008年1月—2013年5月之间77例诊断为原发性肝癌自发性破裂的住院患者与95例同期内未发生肝癌破裂的原发性肝癌患者资料，比较两组的临床特征，找出原发性肝癌自发性破裂的危险因素，并构建多因素logistic回归模型以评估肝癌自发性破裂的风险。结果：多因素logistic回归分析发现中到大量腹水、肝硬化、肿瘤突出肝脏表面、最大肿瘤的长径≥5 cm这4项为原发性肝癌自发性破裂的独立危险因素（均P＜0.05）。绘制所构建logistic回归模型的受试者工作特征曲线，其曲线下面积为0.862（ P＜0.05）。结论：最大肿瘤长径≥5 cm、肿瘤突出肝脏表面、肝硬化、中到大量腹水是原发性肝癌发生自发性破裂的独立危险因素，基于这四项因素构建的logistic回归模型可有效评估原发性肝癌自发性破裂发生的风险。

Objective： To establish a prediction model for spontaneous rupture of primary liver cancer.Methods： The clinical data of 77 patients with spontaneous rupture of primary liver cancer and 95 primary liver cancer patients without spontaneous rupture were collected and compared.The risk factors of spontaneous rupture of primary liver cancer were analyzed with multivariate logistic regression.Results： Multivariate logistic regression analysis revealed that moderate or severe ascites, liver cirrhosis, protrusion of tumor from the liver surface, tumor size≥5 cm were independent risk factors of spontaneous rupture of primary liver cancer.The area under the receiver operating characteristic curve of the established model for spontaneous rupture was 0.862 （ P〈0.05） .Conclusion：The established model base on the severity of ascites, liver cirrhosis, protrusion of tumor and large tumor size can effectively estimate the risk of spontaneous rupture of primary liver cancer.