肝纤维化血清学模型预测HBV相关肝细胞癌经肝动脉化疗栓塞序贯射频消融后复发

Serological models of liver fibrosis for predicting recurrence of HBV-related hepatocellular carcinoma after transcatheter arterial chemoembolization plus radiofrequency ablation

目的探讨肝纤维化血清学模型预测早期乙型肝炎病毒(HBV)相关肝细胞癌(HCC)经导管肝动脉化疗栓塞(TACE)序贯射频消融(RFA)后复发的价值。方法回顾性分析45例经TACE序贯RFA治疗的早期HBV相关HCC患者,采用术前实验室指标构建评估肝纤维化的S指数、天冬氨酸转氨酶与血小板比值指数(APRI)、白蛋白与总胆红素比值指数(ALBI)及谷氨酰转移酶与血小板比值指数(GPRI)4种血清学模型;以受试者工作特征(ROC)曲线评价模型预测HCC复发的效能,以COX比例风险模型分析HCC复发危险因素。结果治疗后随访期间14例HCC复发,复发与未复发患者间S指数、APRI、ALBI、GPR差异均有统计学意义(P均<0.05)。S指数预测复发的效果最优,其曲线下面积(AUC)为0.853,敏感度和特异度分别为92.90%和77.40%,预测截断值为0.49;S指数>0.49是HCC复发的独立危险因素(P<0.05)。结论肝纤维化血清学S指数与经TACE序贯RFA治疗的HCC患者肿瘤复发相关;对S指数>0.49的高危复发HCC患者应密切随访。

Objective To explore the value of serological models of liver fibrosis for predicting recurrence of hepatitis B virus(HBV)-related early hepatocellular carcinoma(HCC)treated with transcatheter arterial chemoembolization(TACE)plus radiofrequency ablation(RFA).Methods Totally 45 patients with early HBV-associated HCC who received sequential TACE and RFA were retrospectively analyzed.The fibrosis markers were built with pre-treatment laboratory data including S index,aspartate aminotransferase to platelet ratio index(APRI),albumin to total bilirubin ratio index(ALBI)and glutamyltransferase to platelet ratio index(GPRI).Receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic efficiencies of different models for predicting tumor recurrence.COX proportional hazards model was used to evaluate the predictors of recurrence.Results Tumor recurrence was observed in 14 of 45 patients during follow-up period.Statistically significant differences of S index,APRI,ALBI and GPRI were detected between patients with HCC recurrence and non-recurrence(all P<0.05).S index was the optimal model with AUC of 0.853.Taken 0.49 as the cut-off value,the sensitivity and specificity of S index for predicting tumor recurrence was 92.90%and 77.40%,respectively.S index>0.49 remained significant independent risk factors for recurrence of HCC(P<0.05).Conclusion S index was associated with HCC recurrence in patients with HBV-related HCC after TACE plus RFA.High risk patients with S index>0.49 should be closely followed up.