肝细胞癌微血管侵犯相关危险因素分析及预测模型的构建

The risk factor analysis and predictive model construction of microvascular invasion inhepatocellular carcinoma

目的探究肝细胞癌微血管侵犯(MVI)的相关危险因素,并构建MVI的预测模型。方法分析首次行原位肝移植的178例肝细胞癌患者的临床资料并根据术后病理结果分为MVI阳性组(76例)及MVI阴性组(102例)。收集患者术前一般资料、术前CT或MRI检查结果、术前实验室检查结果、病理结果,并对患者进行随访,记录所有患者的无复发生存时间。通过受试者工作特征(ROC)曲线分析甲胎蛋白(AFP)、天冬氨酸转氨酶/淋巴细胞比值(ALRI)、肿瘤最大直径、γ-谷氨酰转移酶/淋巴细胞计数比值(GLR)和中性粒细胞/淋巴细胞比值(NLR)对于MVI的诊断价值,并确定最佳截断值;多因素Logistic回归分析MVI的独立危险因素,并建立预测评分模型。通过评分模型的最佳截断值将患者分为MVI高危组(3~4分,67例)及MVI低危组(0~2分,111例),绘制Kaplan-Meier生存曲线,比较2组的无复发生存率。结果与MVI阴性组相比,MVI阳性组患者中多个肿瘤、肿瘤最大直径>3.75 cm、术前AFP>53.8μg/L、NLR>3、GLR>85.84以及ALRI>75.36比例较高(P<0.05)。肿瘤最大直径>3.75 cm、术前AFP>53.8μg/L、GLR>85.84、ALRI>75.36是肝细胞癌患者MVI的独立危险因素(P<0.05),由上述危险因素构成的评分系统拟合优度良好(χ^(2)=2.553,P=0.862),曲线下面积=0.787,P<0.01,最佳截断值为2,特异度为0.814,敏感度为0.632。生存分析结果显示,MVI低危组患者术后无复发生存率明显高于高危组患者(Log-rankχ^(2)=37.584,P<0.01)。结论术前GLR、ALRI、AFP及肿瘤最大直径是MVI的独立危险因素,由其组成的预测模型对于术前MVI及术后复发情况具有一定的预测价值。

Objective To explore the related risk factors of microvascular invasion(MVI)in hepatocellular carcinoma(HCC),and to construct a predictive model of MVI.Methods The clinical data of 178 patients with HCC who underwent orthotopic liver transplantation for the first time were analyzed.Patients were divided into the MVI positive group(76 cases)and the MVI negative group(102 cases)according to postoperative pathological results.The preoperative general information,preoperative CT or MRI examination results,preoperative laboratory examination results,and pathological results of the patients were collected,and the patients were followed up.The recurrence-free survival(RFS)time was recorded for all patients.The diagnostic values of alpha-fetoprotein(AFP),aspartate aminotransferase to lymphocyte ratio(ALRI),tumor maximum diameter,γ-glutamyl transpeptidase to lymphocyte count ratio(GLR)and neutrophil to lymphocyte ratio(NLR)were analyzed through receiver operating characteristic(ROC)curve for the diagnosis of MVI,and the optimal cut-off value was determined.Multivariate Logistic regression was used to analyze the independent risk factors of MVI,and a predictive scoring model was established.The patients were divided into the MVI high-risk group(3-4 points,67 cases)and the MVI low-risk group(0-2 points,111 cases)according to the optimal cut-off value of the scoring model.The Kaplan-Meier survival curve was drawn to compare the RFS rate of the two groups.Results Compared with the MVI-negative group,there were higher proportions of multiple tumors,tumor maximum diameter>3.75 cm,preoperative AFP>53.8μg/L,NLR>3,GLR>85.84 and ALRI>75.36 in the MVI-positive group(P<0.05).The largest tumor diameter>3.75 cm,preoperative AFP>53.8μg/L,GLR>85.84,ALRI>75.36 were independent risk factors for MVI in patients with hepatocellular carcinoma(P<0.05).The scoring system composed of the above risk factors had good goodness of fit(χ^(2)=2.553,P=0.862),area under the curve=0.787,P<0.01,the optimal cut-off value was 2,the specificity was 0.814,and the sensitivity was 0.632.The results of survival analysis showed that the RFS rate of patients was significantly higher in the MVI low-risk group than that of patients in the MVI high-risk group(Log-rankχ^(2)=37.584,P<0.01).Conclusion Preoperative GLR,ALRI,AFP and maximum tumor diameter are independent risk factors for MVI,and the predictive model composed of them has certain predictive value for the presence of MVI before surgery and postoperative recurrence.