乙型肝炎相关性肝细胞性肝癌患者术后生存的危险指数模型的建立

Establishment of predictive index model for postoperative survival in patients with hepatitis B-related hepatocellular carcinoma

目的:建立预测乙型肝炎相关肝细胞性肝癌(HCC)患者切除术后生存情况的危险指数(PI)模型。方法:收集新疆医科大学第一附属医院2007年10月—2009年10月收治的102例乙型肝炎相关HCC行切除术患者的临床资料,Cox风险比例回归方法分析影响患者5年生存的预后的指标,根据分析的结果建立PI模型,并评价所建立模型的准确度。结果:多因素Cox回归模型分析结果显示,中性粒细胞/淋巴细胞比值(NLR)、微血管侵润(MVI)、肿瘤最大直径(MST)、肿瘤数目(AT)、术后行肝动脉灌注化疗栓塞术(TACE)治疗为影响此类患者预后的独立指标(均P<0.05);根据以上指标建立的PI模型:PI=0.317×NLR+0.958×MVI(是=1,否=0)+0.700×MST(<5 cm=0,≥5 cm=1)+0.945×AT(单发=0,多发=1)-1.168×TACE(是=1,否=0);验证结果显示,该PI模型预测患者5年生存的AUC达0.795,界值为1.46,准确度为75.49%。结论:成功建立预测乙型肝炎相关HCC患者切除术后5年生存情况的PI模型,为临床判断该类患者预后及选用合理的治疗方法提供了一定的参考。

Objective： To establish a predictive index （PI） model for estimation of postoperative survival in patients with hepatitis B-related hepatocellular carcinoma （HCC）. Methods： The clinical data of 102 patients with hepatitis B-related HCC undergoing hepatectomy in the First Affiliated Hospital of Xinjiang Medical University during October 2007 to October 2009 were collected. The variables affecting the postoperative 5-year survival of the patients were determined by using COX proportional hazard regression method, then, based on the results from above analyses, the PI model was established and finally the accuracy of the established PI model was verified. Results： Multivariate microvascular invasion COX regression analysis showed that the neutrophil-to-lymphocyte ratio （NLR）, （MVI）, the maximum size of tumor （MST）, the amount of tumor （AT）, postoperative transarterial chemoembolization （TACE） treatment were independent variables affecting the prognosis in these patients （all P〈0.05）. The PI model was established according to the above variables and was expressed as PI=0.317xNLR＋0.958xMVI （Yes=l, No=0） ＋0.700xMST （〈5 cm=0, ≥5 cm=1） ＋0.945xAT （multiple=l, single=0） -1.168xTACE （Yes=l, No=0）. The verification results demonstrated that and the AUC of this model for predicting the 5-year survival of the patients reached 0.795, with the cut-off value of 1.46 and accuracy of 75.49%, respectively. Conclusion： The PI model for predicting the postoperative 5-year survival of patients with hepatitis B-related HCC is established successfull）swhich may be of help to estimate the prognosis and choose a proper treatment plan for these patients in clinical practice.