腹腔镜超声下肝部分切除术后肝细胞癌患者无进展生存期的多因素Logistic回归分析及预测模型构建

Multivariate Logistic regression analysis and prediction model construction of progression free survival of hepatocellular carcinoma after laparoscopic ultrasound partial hepatectomy

目的研究腹腔镜超声(laparoscopic ultrasound,LUS)下肝部分切除术后肝细胞癌(hepatocellular carcinoma,HCC)患者无进展生存期(progression free survival,PFS)的多因素Logistic回归分析及预测模型构建。方法选取112例贵州医科大学附属医院于2018年1月至2020年12月收治的接受LUS下肝部分切除术治疗的HCC患者。所有患者均采用LUS下肝部分切除,记录患者围手术期指标,统计患者围手术期并发症发生情况,患者出院后定期进行电话随访,并嘱患者定期到门诊进行复查,评估患者的PFS。结果患者术中出血量为(322.73±49.50)ml,手术时间为(180.41±26.42)min,引流管置管时间为(3.91±1.21)d,病灶切缘距离为(2.31±0.47)cm,住院时间为(8.73±1.19)d,术后首次肛门排气时间为(2.77±0.68)d。患者术后均未出现腹腔出血,胆汁漏、胸腔积液、肺部感染及切口感染的发生率均为3.57%,总并发症发生率为14.29%。单因素分析显示,患者年龄、肿瘤数目、BCLC分期、Child-Pugh分级和手术切除边缘残留是LUS下肝部分切除术后患者PFS的影响因素,而性别、肿瘤大小、HbeAg是否阳性及术前HBV-DNA是否为阳性对LUS下肝部分切除术后患者PFS无影响(P>0.05)。多因素Logistic回归分析显示,患者年龄、肿瘤数目、BCLC分期、Child-Pugh分级和手术切除边缘残留是LUS下肝部分切除术后患者PFS的独立危险因素(P<0.05)。绘制危险评估模型预测LUS下肝部分切除术后HCC患者PFS的ROC曲线,结果显示,AUC为0.839(95%CI:0.785~0.894,P<0.001),敏感性为77.55%,特异性为66.28%,Hosmer-Lemeshow拟合优度检验r=4.7,P=0.488。结论患者年龄、肿瘤数目、BCLC分期、Child-Pugh分级和手术切除边缘残留是LUS下肝部分切除术后患者PFS的独立危险因素,根据危险因素构建的预测模型对患者PFS具有良好的预测价值。

Objective To study the multivariate Logistic regression analysis and prediction model of progression free survival(PFS)of hepatocellular carcinoma(HCC)after partial hepatectomy under laparoscopic ultrasound(LUS).Methods 112 cases of HCC patients who received LUS partial hepatectomy in Affiliated Hospital of Guizhou Medical University from Jan.2018 to Dec.2020 were selected.All patients underwent partial hepatectomy under LUS.The perioperative indexes of patients were recorded.The perioperative complications of patients were counted.Patients were regularly followed up by telephone after discharge,and told to visit the clinic regularly and the PFS of patients was evaluated.Results The blood loss during the operation was(322.73±49.50)ml,the operation time was(180.41±26.42)min,the drainage tube placement time was(3.91±1.21)d,the distance from the lesion margin was(2.31±0.47)cm,the hospital stay was(8.73±1.19)d,and the first anal exhaust time after operation was(2.77±0.68)d.No abdominal bleeding occurred after operation.Each incidence of bile leakage,pleural effusion,lung infection and incision infection was 3.57%,and the total incidence of complications was 14.29%.Univariate analysis result showed that age,tumor number,BCLC stage,Child-Pugh grade and surgical margin residue were the influencing factors of PFS after LUS partial hepatectomy,while gender,tumor size,HbeAg positive and HBV-DNA positive before operation had no significant influence on PFS after LUS partial hepatectomy(P>0.05).Multivariate Logistic analysis showed that age,tumor number,BCLC stage,Child-Pugh grade and surgical margin residue were independent risk factors for PFS in patients after LUS partial hepatectomy(P<0.05).The ROC curve of risk assessment model for predicting the PFS of HCC after LUS partial hepatectomy was drawn.The results showed that the AUC was 0.839(95%CI:0.785-0.894,P<0.001),the sensitivity was 77.55%,the specificity was 66.28%,and the goodness-of-fit test of Hosmer-Lemeshow result showed r=4.7,P=0.488.Conclusion The age,tumor number,BCLC stage,Child-Pugh grade and surgical margin residue of patients are independent risk factors for PFS after partial hepatectomy under LUS.The prediction model based on risk factors has good predictive value for PFS.