临床-影像学融合列线图评估肝细胞癌磷脂酰肌醇蛋白聚糖3表达

Clinical-imaging fusion nomogram for evaluating expression of glypican-3 in hepatocellular carcinoma

目的 观察临床-影像学融合列线图评估肝细胞癌(HCC)磷脂酰肌醇蛋白聚糖3(GPC3)表达的价值。方法 纳入119例经术后病理确诊HCC患者,其中GPC3阳性89例、阴性30例;按7∶3比例将其分为训练集(n=84)和验证集(n=35)。采用单因素及多因素分析基于临床及MRI筛选HCC表达GPC3的独立影响因素,构建临床-影像学融合模型并绘制列线图,分析其评估HCC表达GPC3的价值。结果 血清甲胎蛋白(AFP)、谷草转氨酶(GOT)、肿瘤最大径及最小表观弥散系数(ADC_(min))为HCC表达GPC3的独立影响因素;基于此建立的临床-影像学融合模型评估训练集HCC表达GPC3的曲线下面积(AUC)、准确率、敏感度及特异度分别为0.82、82.14%、84.13%及76.19%,在验证集分别为0.78、77.14%、84.62%及55.56%;其AUC大于AFP、肿瘤最大径及ADC_(min)(P均<0.05),虽与GOT的AUC无明显差异(P=0.055),但综合判别改善指数显示差别有显著统计学意义(P<0.001)。结论 临床-影像学融合列线图可于术前较好地评估HCC表达GPC3状态。

Objective To observe the value of clinical-imaging fusion nomogram for evaluating the expression of glypican-3(GPC3)in hepatocellular carcinoma(HCC).Methods Totally 119 patients with pathologically confirmed HCC after surgical resection were enrolled,including 89 cases of GPC3 positive and 30 cases of GPC3 negative.The patients were divided into training set(n=84)and validation set(n=35)at a ratio of 7∶3.Based on clinical and MRI data,univariate and multivariate analysis were used to screen the independent impact factors of GPC3 expression of HCC,then a clinical-imaging fusion model was established,and a nomogram was drawn.The value of nomogram for evaluating GPC3 expression of HCC was analyzed.Results Serum alpha-fetoprotein(AFP),glutamic-oxaloacetic transaminase(GOT),the maximum diameter and the minimum apparent diffusion coefficient(ADC_(min))were independent impact factors of GPC3 expression of HCC.The area under the curve(AUC),accuracy,sensitivity and specificity of the clinical-imaging fusion model for evaluating GPC3 expression of HCC was 0.82,82.14%,84.13%and 76.19%in training set,respectively,while was 0.78,77.14%,84.62%and 55.56%in validation set,respectively.The AUC of clinical-imaging fusion nomogram for evaluating GPC3 expression of HCC was higher than that of AFP,the maximum diameter and ADC min of HCC(all P<0.05),though was not significant different with that of GOT(P=0.055),but significant difference was found after integrated discrimination improvement(P<0.001).Conclusion Clinical-imaging fusion nomogram could be used to evaluate GPC3 expression of HCC before surgery.