肝细胞癌门静脉癌栓术后TACE治疗对生存期的影响及危险因素分析

The impact of tace treatment on postoperative survival and hazard factor analysis of hepatocellular carcinoma patients with portal vein tumor thrombus

目的:旨在研究PVTT患者术后行TACE治疗的预后情况,并建立相关临床预测模型。方法:纳入204例行R0切除的PVTT患者,根据是否行TACE治疗,将其分为non-TACE组(n=114)和TACE组(n=90)。对204例患者的OS和RFS数据进行Cox回归分析,获取用于构建列线图的独立因素。使用C指数、校准曲线等方法,评估预测模型的性能和判别力。结果:在204例行R0切除且1个月内未复发的PVTT患者中,TACE组的OS和RFS明显优于non-TACE组(P=0.017、P=0.000)。Cox回归显示影响OS的危险因素有Post TBil、Transfusion、Size和TACE治疗,影响RFS的危险因素有Post TBil、Transfusion、Size、TACE和Post AFP。以上述危险因素构建了与TACE相关的列线图模型。该模型在OS和RFS方面的C指数分别为0.73和0.75。校准曲线表明列线图的预测结果与实际观察结果具有良好的一致性。结论:TACE治疗可以显著提升PVTT患者的OS和RFS,本中心构建的列线图模型,可用于预测PVTT患者的个体生存和复发状况。

Objective:To investigate the postoperative prognosis of patients with PVTT undergoing TACE treatment and establish a relevant clinical predictive model.Methods:204 PVTT patients who underwent R0 resection were included.Based on whether they underwent TACE treatment,they were divided into non-TACE group(n=114)and TACE group(n=90).Cox regression analysis was conducted on OS and RFS data of the 204 patients to obtain independent factors for constructing nomograms.The performance and discriminative ability of the predictive model were assessed using the C-index,calibration curves,and other methods.Results:Among the 204 PVTT patients who underwent R0 resection and had no recurrence within one month,the TACE group showed significantly better OS and RFS than the non-TACE group(P=0.017,P=0.000).Cox regression revealed risk factors affecting OS included Post TBil,Transfusion,Size,and TACE treatment,while factors affecting RFS included Post TBil,Transfusion,Size,TACE,and Post AFP.Nomograms associated with TACE were constructed using these risk factors.The C-index for OS and RFS of this model were 0.73 and 0.75,respectively.Calibration curves indicated good consistency between the predicted and observed outcomes.Conclusion:TACE treatment significantly improves OS and RFS in PVTT patients.The nomogram model developed in this study can predict individual survival and recurrence status in PVTT patients.