肿瘤负荷评分在预测肝癌根治性切除术后复发中的应用

Application of tumor burden score in predicting recurrence after radical resection of HCC

目的探讨肿瘤负荷评分(TBS)对肝细胞癌(HCC)患者行根治性切除术后肿瘤复发的预测作用。方法回顾性分析2015年1月至2017年12月在联勤保障部队第九〇〇医院接受根治性手术治疗的202例肝癌患者的临床资料,其中男性128例,女性74例,年龄(53.66±11.93)岁。受试者工作特征(ROC)曲线评价TBS预测术后肿瘤复发的准确性。单因素及多因素logistic回归确定影响术后肿瘤复发的独立危险因素。绘制列线图,通过校准曲线和C-指数验证。采用Kaplan-Meier生存分析比较两组患者的生存差异。结果TBS预测HCC患者术后肿瘤复发的ROC曲线下面积为0.779(95%CI:0.717~0.842),最佳临界值为6.2,据此将患者分为两组:TBS≤6.2的患者纳入低TBS组(n=133);TBS>6.2的患者纳入高TBS组(n=69)。单因素分析表明,乙型肝炎病毒DNA水平、肿瘤最大径、TBS与术后肿瘤复发相关(均P<0.05);多因素分析显示,TBS>6.2(OR=3.60,95%CI:1.081~12.012,P=0.037)、肿瘤最大径(OR=1.240,95%CI:1.034~1.487,P=0.020)是患者术后复发的独立危险因素。基于上述风险因素构建列线图模型,其C指数达到0.788。Kaplan-Meier生存分析显示,低TBS组患者术后累积生存率和累积无复发生存率均优于高TBS组,差异有统计学意义(均P<0.05)。结论TBS可作为HCC患者根治性切除术后预后的预测指标,TBS和肿瘤最大径是患者术后复发的独立危险因素,构建的列线图模型可用于HCC患者根治性切除术后复发的预测。

ObjectiveTo study the predictive role of tumor burden score(TBS)for tumor recurrence after radical resection in patients with hepatocellular carcinoma(HCC).MethodsClinical data of 202 patients with HCC undergoing radical surgery at the 900th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army,between January 2015 and December 2017 were retrospectively analyzed,including 128 males and 74 females,aged(53.66±11.93)years old.The receiver operating characteristic(ROC)curve was used to assess the accuracy of TBS in predicting postoperative tumor recurrence.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors influencing postoperative tumor recurrence.A nomogram was established and validated using calibration curves and the C-index.Kaplan-Meier survival analysis was utilized to compare survival differences between the two patient groups.ResultsThe area under the ROC curve for TBS in predicting postoperative tumor recurrence in HCC patients was 0.779(95%CI:0.717-0.842),with an optimal cutoff value of 6.2.Univariate analysis revealed that factors such as hepatitis B virus DNA level>500 IU/ml,larger maximum tumor dia-meter,and TBS>6.2 were significant risk factors for postoperative tumor recurrence(all P<0.05).Multivariate analysis further indicated that TBS>6.2(OR=3.60,95%CI:1.081-12.012,P=0.037)and maximum tumor diameter(OR=1.240,95%CI:1.034-1.487,P=0.020)were independent risk factors for postoperative recurrence.Based on these risk factors,a nomogram model was established,achieving a C-index of 0.788.Kaplan-Meier survival analysis showed a better postoperative overall survival and recurrence-free survival of the low TBS group compared to those of the high TBS group(all P<0.05).ConclusionTBS can serve as a predictive indicator for the recurrence after radical resection in patients with HCC.Both TBS and tumor size are independent risk factors for postoperative recurrence.The nomogram model can be used for predicting recurrence following radical resection in HCC patients.