BCLC 0~A期肝细胞癌病人R0切除术后肝外转移风险预测列线图的构建

Nomogram for predicting the risk of extrahepatic metastasis in BCLC 0-A stage hepatocellular carcinoma patients after R0 hepatectomy

目的分析巴塞罗那临床肝癌分期系统(BCLC)0~A期肝细胞癌(hepatocellular carcinoma,HCC)病人R0切除术后肝外转移发生的独立危险因素,并构建肝外转移风险预测列线图。方法收集2014年1月1日至2016年12月31日在华中科技大学同济医学院附属同济医院肝脏外科就诊且符合纳入标准的HCC病人临床资料。根据术后首次复发部位是否包含肝脏以外其他器官,研究人群被分为肝外转移组和非肝外转移组。随后,依据术前临床资料构建肝外转移风险预测模型及列线图,并评估其预测能力。最后,应用临床决策曲线评估模型的临床应用价值。结果共351例病人被纳入,包括肝外转移组36例(10.3%)和非肝外转移组315例(89.7%)。肝外转移的独立危险因素包括:甲胎蛋白(AFP)分级[比值比(OR)=1.580,95%置信区间(CI)(1.182,2.144),P=0.002],肿瘤直径[OR=1.103,95%CI(1.002,1.209),P=0.039]和瘤内坏死(是)[OR=2.379,95%CI(1.042,5.222),P=0.034]。肝外转移风险预测模型和列线图预测能力评价:受试者工作特征曲线下面积(AUC)值为0.740,95%CI(0.663,0.816);Hosmer-Lemeshow(H-L)拟合优度检验:P=0.653。临床决策曲线显示该模型具有一定的临床应用价值。结论BCLC 0~A期HCC病人R0切除术后发生肝外转移的独立危险因素包括AFP分级、肿瘤直径和瘤内坏死。肝外转移风险预测列线图在识别肝外转移高风险病人方面表现出了较好的能力。

Objective To explore the risk factors of extrahepatic metastasis in Barcelona clinic liver cancer(BCLC)0-A stage hepatocellular carcinoma(HCC)patients after R0 hepatectomy and construct a nomogram for predicting the risk of extrahepatic metastasis.Methods From January 1,2014 and December 31,2016,clinical data were collected from 351 hospitalized HCC patients fulfilling the inclusion criteria.And they were divided into extrahepatic and non-extrahepatic metastasis groups based upon whether or not the site of initial recurrence contained an extrahepatic organ.Based upon preoperative clinical data,model and nomogram for predicting the risk of extrahepatic metastasis were developed and their predictive performances evaluated.Finally clinical decision curve was utilized for evaluating the clinical application value of risk prediction model.Results There were extrahepatic metastasis group(n=36,10.3%)and non-extrahepatic metastasis group(n=315,89.7%).By Logistic regression,the independent risk factors for extrahepatic metastasis were identified,including alpha fetoprotein(AFP)grade[odds ratio(OR)=1.580,95%confidence intervals(CI):1.182,2.144,P=0.002],tumor diameter(OR=1.103,95%CI:1.002,1.209,P=0.039)and tumor necrosis(definite)(OR=2.379,95%CI:1.042,5.222,P=0.034).And the model had an excellent predictive capability:area under receiver operating characteristic curve(AUC)was 0.740 with 95%CI 0.663-0.816 and Hosmer-Lemeshow(H-L)test p value 0.653.Finally clinical decision curve indicated that the model had decent clinical application value as well.Conclusion The independent risk factors for extrahepatic metastasis in BCLC 0-A stage HCC patients after R0 hepatectomy include AFP grade,tumor diameter and tumor necrosis.And the nomogram of extrahepatic metastatic risk shows an excellent capability of identifying high-risk patients.