标准残肝体积分数联合Child-Pugh评分在大肝癌γ-SBRT治疗前的风险评估价值

The research for risk assessment value of SFLVR associated with the Child-Pugh before γ-SBRT for large liver cancer

目的:探讨标准残肝体积分数(SFLVR)联合Child-Pugh评分在大肝癌伽玛刀立体定向放射治疗(γ-SBRT)前的风险评估价值及可行性研究。方法:对60例行γ-SBRT的原发孤立性大肝癌患者进行前瞻性研究,根据治疗后肝功能代偿情况将其分为肝功能代偿良好组(44例)与肝功能代偿不良组(16例),对治疗前生化检查及一般情况进行差异性分析,多因素评估治疗前肝脏储备功能,找出引起伽玛刀治疗后肝功能不全的高危因素,与Child-Pugh评分联合构建新的评分系统,并对新系统进行评价。结果:肝功能代偿良好组与肝功能代偿不良组之间计划体积(PTV)、残肝体积(FLV)、标准残肝体积(SFLV)、标准残肝分数(SFLVR)和凝血酶原时间(PT)相比,差异有统计学意义(t=-4.912,t=7.304,t=6.941,t=6.942,t=-7.624;P<0.05);二元Logistic回归分析,筛选高危因素,与Child-Pugh分级联合构建新的评分系统(Child-Pugh^(New));经ROC分析,Child-Pugh^(New)预测治疗后肝功能不全的临界值为10.5,曲线下面积(AUC)值为0.923,有较高准确性,其灵敏度为93.8%,特异度为84.1%。结论:新评分系统能够在孤立性大肝癌γ-SBRT前较好的预测肝脏储备功能,指导治疗后评价;以Child-Pugh^(New)>10.5作为预防伽玛刀治疗后肝功能不全的临界值可行。

Objective： To discuss the risk assessment value and feasibility of standard future liver volume ratio（SFLVR） associated with Child-Pugh score before Gamma knife stereotactic radiotherapy for large liver cancer. Methods： A prospective study was applied to 60 cases of primary isolated large liver cancer patients with the treatment of gamma knife stereotactic radiotherapy; patients were divided into two groups（ well liver function compensation group, 44 cases; poor liver function compensation group, 16 cases） according to the liver function compensation after treatment; the differences analysis of biochemical test and general situation before treatment were analyzed; liver reserve function was assessed before treatment by multi-factor analysis in order to find the high risk factors of hypohepatia after used Gamma knife stereotactic radiotherapy, and to establish a new scoring system with the Child-Pugh score; and then to evaluate the new system. Results： There were statistically significant between the two groups in 5 indicators： the planning target volume（PTV）, future liver volume（FLV）, standard future liver volume（SFLV）, standard future liver volume ratio（SFLVR） and prothrombin time（PT）（t=-4.912, t=7.304, t=6.941, t=6.942, t=-7.624; P〈0.05）.The risk factors were screened by binary Logistic regression analysis, and associated with the Child-Pugh score together to establish a new scoring system（ChildPugh^（New））; through ROC analysis, the critical value of hypohepatia predicted by Child-Pugh^（New） was 10.5, the area under the curve（AUC） was 0.923, besides, this Child-Pugh^（New） was higher accuracy and its sensitivity and specificity were 93.8% and 84.1%, respectively. Conclusion： New scoring system can predict the liver reserve function before Gamma knife stereotactic radiotherapy for large liver cancer, and guide the evaluation of post-treatment; Child-Pugh^（New） 10.5 as the critical value is feasible for preventing hypohepatia after gamma knife treatment.