肝脏小病灶术前评分系统的建立及在小肝癌预测中的应用

Application of a preoperative scoring system for small liver lesions in predicting small hepatocellular carcinoma

背景小肝癌(small hepatocellular carcinoma,SHCC)患者的治疗仍以手术为主,早期治疗可明显改善患者的预后.如何提高肝脏小病灶患者的SHCC的诊断率是临床医生面临的难题.因此,评估肝脏小病灶患者患小肝癌的风险并采取相应的干预措施对延长患者生存期至关重要.目的本研究旨在通过临床常见指标初步建立肝脏小病灶术前评分系统,并探索其在SHCC临床诊断中的应用价值.方法回顾性分析2014-11/2022-12因肝脏小病灶在我院行手术治疗的243例患者的临床资料,采用多因素Logistic回归分析筛选两组患者中具有显著性差异的变量,并对根据筛选出的主要危险因素权重进行赋值,建立肝脏小病灶术前评分系统,最后采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析评估其诊断SHCC的效能.结果Logistic回归分析显示,合并病毒性肝炎、合并肝硬化、术前AFP水平升高、影像学诊断恶性肿瘤这4个变量与SHCC的发生具有显著性相关(P<0.05).ROC分析显示,肝脏小病灶术前评分系统诊断恶性肿瘤的准确性为0.864,临界值为3.5分,再根据两组患者分值分布情况及ROC分析结果将患者发生SHCC的风险程度进行分级分析.结论根据临床常用指标初步建立的肝脏小病灶术前评分系统对早期诊断肝脏小病灶良恶性具有较好的诊断效能.

BACKGROUND The treatment of small hepatocellular carcinoma(SHCC)is mainly based on surgical procedures,and early treatment can significantly improve the prognosis.How to improve the diagnostic rate of SHCC in patients with small liver lesions is a challenge faced by clinical doctors.Therefore,assessing the risk of SHCC in patients with small liver lesions and taking corresponding intervention measures are crucial for prolonging patient survival.AIM To evaluate the application value of a preoperative scoring system for small liver lesions established based on common clinical indicators in the clinical diagnosis of SHCC.METHODS The clinical data of 243 patients with small liver lesions who underwent surgery at our hospital from November 2014 to December 2022 were retrospectively analyzed.Multivariate logistic regression analysis was used to screen the variables with significant differences between the two groups of patients,and the weights of the main risk factors were assigned according to the screened values.A preoperative scoring system for small liver lesions was established.Finally,receiver operating characteristic curve(ROC)analysis was performed to evaluate its efficacy in the diagnosis of SHCC.RESULTS Logistic regression analysis showed that four variables,including viral hepatitis,cirrhosis,preoperative AFP level elevation,and imaging diagnosis of malignant tumor,were significantly associated with the occurrence of SHCC(P<0.05).ROC analysis showed that the accuracy of the preoperative scoring system for small liver lesions in the diagnosis of malignant tumors was 0.864,and the cut-off value was 3.5.Based on the distribution of scores and ROC analysis results of the two groups of patients,the risk of developing SHCC in patients can be graded and analyzed.CONCLUSION The preoperative scoring system of small liver lesions has good efficacy for early diagnosis of benign and malignant small liver lesions.