肝细胞癌患者术后早期复发的危险因素分析及风险评估模型构建

Analysis of risk factors and construction of risk scoring model for early postoperative recurrence of hepatocellular carcinoma patients

背景与目的:术后早期复发是影响肝细胞癌患者预后的主要因素,本研究探讨影响肝细胞癌患者术后早期复发的危险因素并构建评估模型,为预测复发风险、改善预后提供依据。方法:回顾性分析2011—2016年华中科技大学同济医学院附属同济医院收治的225例肝细胞癌患者,分析患者术后早期复发(2年内复发)情况,运用Logistic回归模型确定早期复发的独立危险因素,用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价变量的预测早期复发的效能,用Cox回归方程建立早期复发的风险评分模型。结果:225例患者中,术后早期复发130例(57.8%)。肿瘤数目、γ-谷氨酰转肽酶(γ-GT)、中性粒细胞-淋巴细胞比值(NLR)为肝细胞癌患者术后早期复发的独立危险因素(均P<0.05)。γ-GT、NLR以及γ-GT与NLR联合预测患者术后早期复发的AUC分别为67.6%、59.1%、70.4%。将肿瘤个数、γ-GT、NLR纳入回归方程,建立风险评分模型后,根据HR值,将γ-GT>108 U/L赋值为1,NLR>2.11赋值为2,肿瘤个数>1赋值为3,否则赋值为0,可得危险评分界值为0~6分。根据此模型,低危组(<3分)与高危组(≥3分)患者1、3、5年的累积无病生存率分别为76.9%、44.5%、32.8%与33.4%、20.1%、6.69%,差异有统计学意义(P<0.001)。结论:肿瘤个数、γ-GT、TNLR是肝细胞癌患者术后早期复发的独立危险因素,所构建的风险预测模型可用来对肝癌患者早期复发进行危险分层,从而有助于选择恰当的治疗方案改善患者预后。

Background and Aims:Early postoperative recurrence is the main factor affecting the prognosis of hepatocellular carcinoma (HCC) patients.This study was conducted to investigate the risk factors for early recurrence in HCC patients after hepatectomy and establish an evaluation model,so as to provide basis for predicting recurrence risk and improving prognosis.Methods:The clinical data of 225 patients with HCC treated in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology between 2011 and 2016 were retrospectively analyzed.The occurrence of early postoperative recurrence (recurrence with 2 years after hepatectomy) among the patients were analyzed.The independent risk factors for early recurrence were determined by Logistic regression model,the efficiencies of the variables in predicting the early recurrence were evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC),and the risk scoring model for early recurrence was established by Cox regression equation.Results:Among the 225 patients,early postoperative recurrence occurred in 130 cases (57.8%).Tumor number,γ-glutamyl transpeptidase (γ-GT),and neutrophil-lymphocyte ratio (NLR) were independent risk factors for early postoperative recurrence in HCC patients (all P<0.05).The AUC of serum γ-GT,NLR and the combination of γ-GT and NLR for prediction early postoperative recurrence were 67.6%,59.1% and 70.4%,respectively.After risk scoring model was created by incorporating tumor number,γ-GT and NLR into the regression equation,a code of 1 was assigned to γ-GT >108 U/L,2 was assigned to NLR>2.11,and 3 was assigned to tumor number >1,otherwise 0 was assigned,according to the HR values.The possible score given bythe risk scoring model ranged from 0 to 6.According to this model,the 1-,3-and 5-year disease-free survival rates were 76.9%,44.5% and 32.8% in patients in low risk group (score <3),and were 33.4%,20.1%,and 6.69% in patients in high risk group (score ≥3),and the difference had statistical significance (P<0.001).Conclusion:Tumor number,γ-GT and NLR are independent risk factors for early postoperative recurrence in HCC patients.The established prediction model can be used for stratifying the risk of early recurrence in HCC patients,and thereby may help choose an appropriate treatment plan to improve the prognosis of the patients.