经导管动脉化疗栓塞成功转化的初始不可切除肝癌术前预测模型的临床研究

The establishment of preoperative predictive model used for predicting TACE-transformed initiallyinoperable HCC: a clinical study

目的 了解经导管动脉化疗栓塞(TACE)联合补救性肝切除(SLR)治疗初始不可切除肝细胞癌(HCC)的疗效及其影响因素,构建SLR术前选择性预后预测模型。方法 回顾性分析2010年1月至2016年12月在复旦大学附属中山医院接受TACE+SLR治疗的119例初始不可切除HCC患者的临床资料。随访36个月,存活时间≥36个月患者82例(长期存活组),存活时间<36个月患者37例(短期存活组)。通过卡方检验和Cox多因素回归模型确定SLR前的关键因素,构建接受TACE+SLR治疗HCC患者的SLR术前选择性预后预测Nomogram模型。结果 119例患者的1、2、3年总生存率(OS)分别为90.8%、80.6%、68.6%。SLR术前AFP>20 ng/mL、癌灶数目≥4个、TACE治疗后肿瘤负荷降低<0.15、门脉癌栓(PVTT)和主瘤最大径>10 cm等是影响预后、增加死亡风险的SLR术前关键因素。基于上述5个关键因素构建新的SLR前预后预测Nomogram模型,其C指数=0.781(95%CI:0.714~0.848),具有较好的预测患者生存的准确性和区分能力。结论 TACE联合SLR治疗初始不可切除肝癌患者疗效确切。基于SLR前AFP水平、癌灶数目、肿瘤负荷下降水平、PVTT、主瘤最大径构建的Nomogram模型能较好地预测初始不可切除HCC患者接受TACE+SLR治疗的预后。

Objective To analyze the curative effect and the factors influencing the prognosis of transcatheter arterial chemoembolization(TACE) combined with salvage liver resection(SLR) in treating initiallyinoperable hepatocellular carcinoma(HCC), based on which to establish a pre-SLR selective prognosis predictive model. Methods The clinical data of 119 patients with initially-inoperable HCC, who received TACE+SLR treatment at the Affiliated Zhongshan Hospital of Fudan University of China between January 2010 and December 2016, were retrospectively analyzed. The patients were followed up for 36 months. Based on the survival time(ST), the patients were divided into long-term survival group(ST≥36 months, n=82) and short-term survival group(ST<36 months, n=37). Chi-square test and Cox multivariate regression model were used to determine the pre-SLR key factors, based on which the pre-SLR prognosis predictive nomogram model used for HCC patients was established. Results In the 119 patients, the 1-, 2-and 3-year overall survivals(OS) were 90.8%,80.6% and 68.6% respectively. The pre-SLR AFP>20 ng/mL, number of tumor lesions≥4, post-TACE reduction ratio of tumor load<0.15, portal vein tumor thrombus(PVTT), and maximum diameter of the main tumor >10 cm were the pre-SLR key factors affecting the prognosis and increasing the risk of death. The pre-SLR prognosis predictive nomogram model was constructed based on the above five key factors, with a C-index of0.781(95%CI=0.714-0.848). This nomogram model had a better accuracy and discriminative ability in predicting patient survival. Conclusion For the treatment of initially-inoperable HCC, TACE+SLR has reliable effect.The nomogram model, which is constructed on the basis of pre-SLR AFP level, number of tumor lesions,post-TACE reduction ratio of tumor load, PTVV and maximum diameter of the main tumor, can well predict the prognosis of patients with initially-inoperable HCC after receiving TACE +SLR treatment.(J Intervent Radiol, 2022, 31: 670-674)