基于列线图评分预测内镜治疗肝细胞癌患者合并食管胃静脉曲张破裂出血的预后

Predicting the prognosis of esophageal and gastric variceal bleeding in patients with hepatocellular carcinoma treated with endoscopy based on column chart score

目的研究影响内镜治疗肝细胞癌患者合并食管胃静脉曲张破裂出血的预后因素。方法纳入2008年1月1日至2014年12月31日确诊为肝细胞癌并因食管胃底静脉曲张破裂出血行内镜治疗预防再出血的192例患者,建立列线图预测模型并评估模型效能。结果192例患者1年、2年和5年的累积无再出血率分别为52.0%(95%CI:45.1%~59.9%)、41.2%(95%CI:34.2%~49.6%)和34.1%(95%CI:27.1%~42.9%),1年、2年和5年的累计生存率为51.5%(95%CI:44.6%~59.5%)、45.9%(95%CI:38.8%~54.3%)和32.1%(95%CI:23.2%~44.4%)。男性、BCLC-C/D期、早期内镜治疗和未接受肝移植是预测再出血的因素;男性、BCLC-C/D期、未接受肝移植、合并糖尿病是预测患者死亡的预测因素。结论内镜治疗食管胃静脉曲张破裂出血的肝细胞癌患者安全有效,本研究建立的列线图模型对预测患者预后有较好的临床价值。

Objective To evaluate the efficacy of secondary prophylactic endoscopic therapy for variceal bleeding,long-term prognosis and identify the prognostic factors in patients with hepatocellular carcinoma.Methods Patients with hepatocellular carcinoma who received endoscopic therapy for variceal bleeding was included from Jan.1st 2008 to Dec.31st 2014.Results The cumulative 1-,2-and 5-year rebleeding rates of 192 patients were 52.0%(95%CI:45.1%-59.9%),41.2%(95%CI:34.2%-49.6%)and 34.1%(95%CI:27.1%-42.9%).The overall 1-,2-and 5-year cumulative survival rates were 51.5%(95%CI:44.6%-59.5%),45.9%(95%CI:38.8%-54.3%)and 32.1%(95%CI:23.2%-44.4%).Male,BCLC-C/D stage,early endoscopic treatment,without liver transplantation and without splenectomy were independent predictors of bleeding relapse.Male,BCLC-C/D stage,without liver transplantation and diabetes mellitus were independent predictors of death.Conclusion Endoscopic therapy is efficient in secondary prophylaxis for variceal bleeding in patients with hepatocellular carcinoma.Nomogram model is useful in prediction of prognosis.