基于剪切波弹性成像技术构建肝细胞癌切除术后肝衰竭预测模型

A model based on shear wave elastography to predict post-hepatectomy liver failure in patients with hepatocellular carcinoma

目的:建立基于二维剪切波弹性成像(2D-SWE)技术的肝细胞癌(HCC)切除术后肝衰竭(PHLF)预测模型。方法:纳入2018年8月至2019年7月于中山大学附属第一医院肝胆外科行肝切除术的HCC患者101例。所有患者术前均行实验室检验、肝剪切波弹性成像检查及上腹部增强CT或MRI检查,以获取肝功能、肝脏硬度(LS)值及肝内肿瘤相关指标。根据国际肝脏外科研究小组(ISGLS)定义判断PHLF,二元Logistic回归分析构建PHLF预测模型,利用ROC曲线分析及Hosmer-Lemeshow检验评估并比较预测模型、ALBI评分、MELD评分及Child-Pugh评分预测PHLF的效能。结果:101例患者中39例发生PHLF(38.9%)。Logistic回归分析显示国际标准化比值(OR=1.09,P=0.026)、LS(OR=1.297,P=0.004)及肿瘤最大径(OR=1.191,P=0.015)是PHLF发生的独立风险因素。基于上述因素构建的模型预测PHLF的ROC曲线下面积为0.842(95%CI=0.763~0.921),显著大于ALBI评分、MELD评分及Child-Pugh评分预测PHLF的ROC曲线下面积(0.626~0.688,P<0.05);Hosmer-Lemeshow检验提示模型具有良好的校准度(P=0.498)。结论:基于剪切波弹性成像技术构建的PHLF预测模型具有良好的预测效能,有助于外科医师筛选适合手术的HCC患者。

Objective To establish a model based on two-dimensional shear wave elastography(2D-SWE)for predicting post-hepatectomy liver failure(PHLF)among patients with hepatocellular carcinoma(HCC).Methods One hundred and one consecutive patients with HCC undergoing hepatectomy from August 2018 to July 2019 were enrolled prospectively in the First Affiliated Hospital of Sun Yat-Sen University.Laboratory tests,shear wave elastography in liver parenchyma,and abdominal contrast-enhanced computed tomography(CT)or magnetic resonance imaging(MRI)were performed preoperatively.Liver functional reserve,liver stiffness(LS),and tumor-related imaging parameters were assessed.PHLF was defined according to the definition of International Study Group of Liver Surgery Recommendations(ISGLS).A predictive model was developed by logistic regression analysis and the performance thereof was evaluated by receiver operating characteristic(ROC)curve analysis and Hosmer-Lemeshow test.Results PHLF occurred in 39 patients(38.9%).Logistic regression analysis identified that international normalized ratio(OR=1.09,P=0.026),LS(OR=1.297,P=0.004)and the largest nodule diameter(OR=1.191,P=0.015)were independent risk factors of PHLF.The area under curve(AUC)of the model was 0.842(95%CI=0.763-0.921),which was significantly higher than those of ALBI score,MELD score and Child-Pugh score(AUC 0.626-0.688,P<0.05).The model also showed good calibration in Hosmer-Lemeshow test(P=0.498).Conclusions A model based on 2D-SWE provides good preoperative prediction of PHLF among patients with HCC,which might have the potential in better customizing treatment strategy in those patients.