原发性肝癌伴门静脉癌栓患者预后的术前预测模型建立

The establishment of preoperative prediction model for the prognosis of patients with primary liver cancer and portal vein tumor thrombus

目的研究原发性肝癌伴门静脉癌栓患者预后的术前预测模型。方法纳入86例接受肝癌根治术联合肝断面取栓术的原发性肝癌伴门静脉癌栓患者作为研究对象,随访患者术后2年生存率,采用logistic多因素分析原发性肝癌伴门静脉癌栓患者预后的独立影响因子,并建立术前预测模型。结果随访2年,86例患者中,死亡18例,存活68例(79.07%)。logistic多因素分析显示Child-Pugh肝功能分级(OR:1.682,P=0.029)、肿瘤直径(OR:2.279,P<0.01)及肿瘤分期(OR:1.231,P=0.006)是原发性肝癌伴门静脉癌栓患者不良预后的高危因素,Alb是患者不良预后的保护因素(OR:0.712,P=0.002)。根据logistic多因素分析结果建立患者不良预后术前预测模型为Y=1.682X1+2.279X2+1.231X3-0.712X4(X1为Child-Pugh肝功能分级,X2为肿瘤直径,X3为肿瘤分期,X4为Alb),经受试者工作特征曲线(ROC)分析显示预测模型判断不良预后的AUC为0.810,最佳截断值为7.500分。结论原发性肝癌伴门静脉癌栓患者预后与肝功能、Alb、肿瘤分期及肿瘤直径相关,术前预测模型的建立有助于判断患者预后。

Objective To establish a preoperative prediction model for the prognosis of patients with primary liver cancer and portal vein tumor thrombus.Methods Eight-six cases of primary liver cancer with portal vein tumor thrombus who received the radical resection of liver cancer in combination with section thrombectomy were included as the research objects.Their 2-year survival rates were recorded by followed up.Logistic multivariate analysis was used to obtain the independent factors that were associated with the prognosis of patients with primary liver cancer and portal vein tumor thrombus.These factors were used to establish a preoperative prediction model.Results The 86 patients were followed up for 2 years in which 18 cases died and 68 cases survived,with a 2-years survival rate of 79.07%.By logistic multivariate analysis it was found that Child Pugh liver function grade(OR=1.682,P=0.029),tumor diameter(OR=2.279,P=0.000)and tumor stage(OR=1.231,P=0.006)were the risk factors of poor prognosis in patients with primary liver cancer and portal vein tumor thrombus.Serum albumin(Alb)level was a protective factor for poor prognosis(OR=0.712,P=0.002).The preoperative prediction model was established as the Y=1.682X1+2.279X2+1.231X3-0.712X4(X1 was Child Pugh liver function grade,X2 was tumor diameter,X3 was tumor stage,X4 was Alb).The receiver operating characteristic curve(ROC)analysis showed that the area under the curve(AUC)of this prediction model was 0.810(S.E.=0.056,95%Cl=0.700-0.921,P=0.000)and the best cut off value was 7.500 scores.Conclusion The prognosis of patients with primary liver cancer and portal vein tumor thrombus is co-related with their liver function,Alb level,tumor stage and tumor diameter.The established preoperative prediction model is helpful in evaluating the patients’prognosis and provide a reference for clinical practice.