肝细胞癌术后复发预测模型建立

Establishment of prediction model for postoperative recurrence of hepatocellular carcinoma

目的探讨肝细胞癌(肝癌)患者根治性切除术后复发的影响因素,并建立预测模型。方法回顾性分析2012年1月至2017年12月在中山大学附属第三医院行根治性切除术的210例肝癌患者临床资料。其中男178例,女32例;平均年龄(51±11)岁。患者均签署知情同意书,符合医学伦理学规定。采用Cox单因素和多因素分析筛选肝癌术后复发的影响因素并建立临床预测模型,对该模型进行似然比检验,评价诊断效能。结果Cox多因素分析显示,外周血中性粒细胞与淋巴细胞绝对值比值(NLR)、血小板与淋巴细胞绝对值比值(PLR)、微血管侵犯、门静脉癌栓、肿瘤最大径、BCLC分期和术后TACE治疗是肝癌术后复发的独立影响因素(HR=1.228,1.003,1.822,2.043,1.009,2.711,0.233;P<0.05)。复发预测指数(PI)=0.205X1+0.003X2+0.600X3+0.714X4+0.009X5+0.168X6+0.997X7-1.455X8,其中X1、X2、X3、X4、X5、X6、X7、X8分别表示NLR、PLR、微血管侵犯,门静脉癌栓、肿瘤最大径、BCLC分期B期、BCLC分期C期和术后TACE治疗。PI值越大,复发风险越高。对预测模型进行似然比检验,差异有统计学意义(χ2=165.762,P<0.001)。结论术前NLR、PLR、微血管侵犯、门静脉癌栓、肿瘤最大径、BCLC分期、术后TACE治疗均为肝癌患者根治性切除术后复发的独立影响因素,术后TACE治疗有助于预防复发。建立的预测模型有较好的预测价值。

Objective To explore the influencing factors of postoperative recurrence of hepatocellular carcinoma(HCC)after radical resection,and to establish its prediction model.Methods Clinical data of 210 patients with HCC who underwent radical resection in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2017 were retrospectively analyzed.Among them,178 patients were male and 32 female,aged(51±11)years.The informed consents of all patients were obtained and the local ethical committee approval was received.The influencing factors of postoperative recurrence of HCC were analyzed by Cox univariate and multivariate analyses,and a clinical prediction model was established.The likelihood ratio test was carried out to evaluate the diagnostic efficiency of the established model.Results Cox multivariate analysis showed that absolute neutrophils-to-lymphocytes ratio(NLR),absolute platelets-to-lymphocytes ratio(PLR),microvascular invasion,portal vein tumor thrombus,the maximum diameter of tumor,BCLC stage and postoperative TACE treatment were the independent influencing factors of postoperative recurrence of HCC(HR=1.228,1.003,1.822,2.043,1.009,2.711,0.233;P<0.05).Recurrent predictive index(PI)=0.205X1+0.003X2+0.600X3+0.714X4+0.009X5+0.168X6+0.997X7-1.455X8,where X1,X2,X3,X4,X5,X6,X7 and X8 represent NLR,PLR,microvascular invasion,portal vein tumor thrombus,the maximum diameter of tumor,BCLC B stage,BCLC C stage and postoperative TACE treatment.The greater the PI value,the higher the risk of recurrence.Significant differences were observed in the likelihood ratio test of prediction model(χ2=165.762,P<0.001).Conclusions Preoperative NLR,PLR,microvascular invasion,portal vein tumor thrombus,the maximum diameter of tumor,BCLC stage and postoperative TACE treatment are the independent influencing factors of HCC recurrence after radical resection.Postoperative TACE treatment contributes to preventing the postoperative recurrence.The prediction model yields high predictive efficiency.