非侵入性肝纤维化诊断模型对肝癌DEB-TACE术后急性肝功能恶化的预测与生存分析

Non⁃Invasive Fibrosis Indexes in Predicting Acute Liver Function Deterioration and Survival after Drug⁃Eluting Beads Transarterial Chemoembolization

目的探讨非侵入性肝纤维化诊断模型对肝细胞癌(HCC)载药微球化疗栓塞(DEB-TACE)术后发生急性肝功能恶化(ALFD)风险的预测及生存分析。方法回顾性分析288例经DEB-TACE治疗的HCC患者的临床资料。按照文中标准将患者分为ALFD组与对照组,对比两组患者的基线资料及术前肝功能指标,采用受试者工作特征(ROC)曲线分析术前Child-Pugh评分、APRI、FIB-4对DEB-TACE术后ALFD的预测价值。利用Kaplan-Meier对数秩检验及Cox风险回归模型分析生存率,通过多因素Cox比例风险回归模型筛选出独立预后影响因素。结果除丙氨酸转氨酶水平外,两组间其他肝功能指标差异均有统计学意义(P<0.05)。术前Child-Pugh评分、APRI、FIB-4的曲线下面积分别为0.763、0.735、0.740,均无显著性差异,APRI、FIB-4最佳截断点值分别为1.42和4.47。分层分析提示,APRI>1.42或FIB-4>4.47是DEB-TACE术后ALFD的危险因素。生存分析表明,APR≤1.42与APRI>1.42时的中位生存期分别为32.5个月、19个月(P=0.005);FIB-4≤4.47与FIB-4>4.47时中位生存期分别为32.5个月、20.5个月(P=0.097);多因素Cox风险回归模型分析得到最大肿瘤直径和门静脉侵犯为独立预后影响因素。结论基于APRI、FIB-4的非侵入性肝纤维化模型对评估肝细胞癌DEB-TACE术后发生ALFD的风险及生存具有一定的临床应用价值。

Objective To investigate Non⁃invasive fibrosis indexes in predicting the risk of acute liver function deterio⁃ration(ALFD)and survival after drug⁃eluting beads transarterial chemoembolization(DEB⁃TACE).Methods The clini⁃cal data of 288 HCC patients treated with DEB⁃TACE were analyzed retrospectively.According to the text's criteria,the pa⁃tients were divided into the ALFD group and control group,and the baseline data and preoperative liver function indices of the two groups were compared.Then receiver operating characteristic(ROC)of Child⁃Pugh score,Kaplan⁃Meier log⁃rank test and Cox risk regression model were used for univariate analysis of survival rate,and the independent prognosis factors were screened out by multivariate analysis.Results Except for ALT,all other liver function indexes showed statistically significant differences in the two groups(P<0.05).The AUCs of Child⁃Pugh score,APRI,and FIB⁃4 were 0.763,0.735,and 0.740 respectively,which the difference had no significance in statistics,also APRI,FIB⁃4 optimal cut⁃off point values of 1.42,and 4.47 respectively.Stratified analysis suggested that APRI>1.42 or FIB⁃4>4.47 were risk factors for ALFD after DEB⁃TACE.Survival analysis showed that the median survival was 32.5 months and 19 months for APR≤1.42 versus APRI>1.42 respectively(P=0.005);and 32.5 months and 20.5 months for FIB⁃4≤4.47 versus FIB⁃4>4.47,respectively(P=0.097).Multi⁃factor Cox risk regression model analysis yielded maximum tumor diameter and portal vein invasion as independent prognostic factors.Conclusion The non⁃invasive fibrosis indexes based on APRI and FIB⁃4 has certain clinical application to assess the risk of ALFD and prognostic survival after DEB⁃TACE for hepatocellular carcino⁃ma.