Correlation between preoperative CT quantitative parameters and prognosis of patients with liver cancer treated with transcatheter arterial chemoembolization and construction of nomogram model for prognostic prediction
Objective To investigate the correlation between preoperative CT quantitative parameters and the prognosis of patients with liver cancer treated by transcatheter arterial chemoembolization(TACE),and to construct a nomogram model for prognostic prediction.Methods A total of 120 patients with liver cancer who received TACE treatment in the Department of Medical Imaging,the Fifth People's Hospital of Puyang City from May 2020 to May 2022 were selected as the research subjects.Spiral CT plain scan and perfusion imaging were performed before surgery,and CT quantitative parameters such as hepatic blood flow(HBF),hepatic artery perfusion(HAP)volume,portal vein perfusion(PVP)volume,hepatic arterial infusion(HAI)index and mean transit time(MTT)were measured.These patients were followed up to May 2023,and according to clinical outcomes,they were divided into the good prognosis group(n=90)and the poor prognosis group(n=30).Gender,age,body mass index(BMI),history of smoking and alcoholism,TNM stage,maximum tumor size,tumor number,complete or incomplete envelope,albumin,platelets,total bilirubin,white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase(AST),alpha-fetoprotein(AFP),HBF,HAP,HAI,and MTT were compared between the two groups.The risk factors affecting the prognosis of liver cancer patients treated with TACE were analyzed by logistic multivariate regression.CT quantitative parameters were screened out by R software to construct a nomogram model for predicting the prognosis of liver cancer patients treated by TACE.The efficiency of this model in predicting the poor prognosis of liver cancer patients treated by TACE was verified by the rms package and Bootstrap internal validation method.Results The proportion of TNM stagesⅢ-Ⅳ,the proportion of incomplete envelope and the levels of AFP,HBF,HAP and HAI in the poor prognosis group were significantly higher than those in the good prognosis group,while MTT in the poor prognosis group was significantly shorter than that in the good prognosis group(P＜0.05).There was no significant difference in gender composition,age,BMI,smoking ratio,ratio of maximum tumor diameter＞5 cm,ratio of tumor number＞1,albumin level,platelet count,total bilirubin level,ALT level,AST level and PVP between the poor prognosis group and the good prognosis group(P＞0.05).Logistic multivariate regression analysis showed that the incomplete envelope[odds ratio(OR)=2.202,95％confidence interval(CI):1.884-2.880,P=0.000],high AFP level(OR=2.187,95％CI:1.818-2.787,P=0.000),high HBF(OR=2.177,95％CI:1.859-2.862,P=0.000),high HAP(OR=2.192,95％CI:1.907-2.909,P=0.000),high HAI(OR=2.212,95％CI:1.926-2.816,P=0.000),and short MTT(OR=2.208,95％CI:1.927-2.954,P=0.000)were the risk factors affecting the prognosis of patients with liver cancer treated by TACE.The measured results were basically consistent with the predicted results based on the nomogram model constructed based on HBF,HAP,HAI and MTT,indicating that the model had good predictive performance.The C-index was 0.908(95％CI:0.787-0.968),indicating that the model had good differentiation and accuracy.Conclusion HBF,HAP,HAI and MTT are risk factors that affect the prognosis of patients with liver cancer treated by TACE.The nomogram model constructed based on the above four CT quantitative parameters has high predictive efficacy.
liver cancertranscatheter arterial chemoembolizationprognosisCT quantitative parametersnomogram model
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