术前抗乙型肝炎病毒治疗对肝细胞癌合并微血管癌栓患者预后的价值及其生存预测模型的建立

Study on the prognostic value of preoperative anti hepatitis B virus therapy in patients with hepatocellular carcinoma complicated with microvascular tumor thrombus and establishment of survival prediction model

目的探究术前抗乙型肝炎病毒(HBV)治疗对肝癌合并微血管癌栓患者预后的影响,并建立其肝癌根治性切除术的预后预测模型。方法收集2013年1月1日至2015年12月31日在中山大学附属第三医院接受根治性切除术的合并微血管癌栓的肝癌患者的临床资料。使用Kaplan-Meier法计算生存曲线,并采用log-rank检验比较术前抗病毒与未抗病毒治疗患者的预后情况,使用单因素、多因素Cox比例风险回归模型筛选预测因子,并采用R软件制作预测列线图,使用区分度和校准度评价建立的预测模型。结果共153例患者纳入本研究,其中女22例、男131例,年龄(51.3±11.7)岁,抗病毒组62例、非抗病毒组91例。log-rank检验结果显示,术前抗病毒治疗组的总生存和无复发生存率均较高(χ^(2)=41.423,54.389;均P<0.001)。多因素Cox回归模型分析结果显示,术前抗HBV病毒治疗(HR=0.301,95%CI:0.171~0.532,P<0.001)、血清甲胎蛋白(AFP)水平(HR=1.226,95%CI:1.157~1.776,P=0.032)、肿瘤直径(HR=1.008,95%CI:1.001~1.016,P=0.02)与总体生存相关。3年和5年生存预测模型的受试者工作特征(ROC)曲线下面积(AUC)分别为0.749(95%CI:0.712~0.782)和0.755(95%CI:0.724~0.593)。结论术前抗HBV治疗可改善合并微血管癌栓的肝癌患者根治性切除术的预后;建立的针对合并微血管癌栓的肝癌患者肝癌根治性切除术预后3年和5年的生存率预测模型较为准确可靠。

Objective To explored the effect of preoperative antiviral therapy on the prognosis of microvascular tumor thrombi patients,and to established a prognostic prediction model for these patients after radical resection of liver cancer.Methods The clinicopathological and survival data of hepatocellular carcinoma patients with microvascular tumor thrombus who underwent radical resection in the Third Affiliated Hospital of Sun Yat-sen University from January 1,2013 to December 31,2015 were retrospectively collected.Kaplan-Meier method was used to calculate the survival curve,and log-rank test was used to compare the prognosis of patients with and without antiviral treatment before operation.Univariate and multivariate Cox proportional hazard regression model was used to screen predictive factors.R software was used to make predictive nomogram,and discrimination and calibration degree were used to evaluate the prediction model.Results Among all 153 patients,22 were female and 131 were male,aged(51.3±11.7)years.The preoperative antiviral therapy significantly improved overall survival and recurrence-free survival(χ^(2)=41.423,54.389;both P<0.001).According to the results of multivariate and regression analysis,preoperative antiviral therapy(HR=0.301,95%CI:0.171-0.532,P<0.001),alpha fetoprotein(HR=1.226,95%CI:1.157-1.776,P=0.032)and tumor size(HR=1.008,95%CI:1.001-1.016,P=0.02)were important prognostic factors for overall survival.The area under curve value of 3-year survival prediction model was 0.749(95%CI:0.712-0.782),and that of 5-year survival prediction model was 0.755(95%CI:0.724-0.793),with good calibration.Conclusions Preoperative anti hepatitis B virus(HBV)therapy can significantly improve the prognosis of patients with hepatocellular carcinoma complicated with microvascular tumor thrombus,we develope the prediction models of 3-year and 5-year survival rate that can improve the reference for clinical work and benefit patients.