首页|肝细胞癌行根治性肝切除术后早期复发的危险因素分析及其预测模型的建立

肝细胞癌行根治性肝切除术后早期复发的危险因素分析及其预测模型的建立

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目的 分析肝细胞癌行根治性肝切除术后早期复发的危险因素并构建列线图预测模型.方法 回顾性收集2017年8月至2021年8月期间在新疆医科大学第一附属医院行根治性肝切除术的肝细胞癌患者的临床资料,同时采用单因素和多因素logistic回归分析筛选肝细胞癌行根治性肝切除术后早期复发的危险因素并据此建立列线图预测模型,采用受试者操作特性曲线和校准曲线对该模型的预测效能进行评价,并用决策曲线分析评估其临床实用性.结果 本研究根据纳入和排除标准纳入了 302例患者,有145例(48.01%)发生了早期复发.多因素logistic回归模型筛选出术前中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率、γ-谷氨酰转移酶、甲胎蛋白、肿瘤大小及微血管侵犯是肝细胞癌行根治性肝切除术后早期复发的影响因素(P<0.05),据此建立的列线图预测模型区分术后早期复发的受试者操作特征曲线下面积为0.858[95%CI(0.816,0.899)],校准曲线评价列线图预测模型的Brier指数为0.152,列线图预测模型的预测值与真实值之间比较接近(Hosmer-Lemeshow检验,P=0.913);决策曲线分析结果显示,当阈值概率在0.1~0.8的范围内,根据模型的预测概率来对肝细胞癌进行干预的临床净收益高于对所有肝细胞癌患者不进行干预和进行干预.结论 本研究结果提示,对于术前中性粒细胞与淋巴细胞比率>2.13、血小板与淋巴细胞比率>108.15、γ-谷氨酰转移酶>46.0 U/L、甲胎蛋白>18.96 μg/L、肿瘤大小>4.9 cm及术前存在微血管侵犯的患者需密切关注其术后早期复发,根据这些风险因素构建的列线图模型具有良好的区分度和准确性,模型的阈值概率范围0.1~0.8范围内具有一定的临床净获益.
Analysis of risk factors and development of nomogram predictive model for early recurrence after curative liver resection for hepatocellular carcinoma
Objective To analyze the risk factors and develop a nomagram predictive model for early recurrence after curative resection for hepatocellular carcinoma(HCC).Methods The clinicopathologic data of the patients with HCC who underwent radical hepatectomy at the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2021 were retrospectively collected.The univariate and multivariate logistic regression analysis were used to screen for the risk factors of early recurrence for HCC after radical hepatectomy,and a nomogram predictive model was established based on the risk factors.The receiver operating characteristic(ROC)curve and calibration curve were used to validate the predictive performance of the model,and the decision curve analysis(DCA)curve was used to evaluate its clinical practicality.Results A total of 302 patients were included based on the inclusion and exclusion criteria,and 145(48.01%)of whom experienced early recurrence.The results of multivariate logistic regression model analysis showed that the preoperative neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),γ-glutamate transferase(GGT),alpha fetoprotein(AFP),tumor size,and microvascular invasion(MVI)were the influencing factors of early recurrence for HCC after radical resection(P<0.05).The nomogram was established based on the risk factors.The area under the ROC curve of the nomogram was 0.858[95%CI(0.816,0.899)],and the Brier index of the calibration curve of the nomogram was 0.152.The predicted result of the nomogram was relatively close to the true result(Hosmer-Lemeshow test,P=0.913).The DCA result showed that the clinical net benefit of intervention based on the predicted probability of the model was higher than that of non-intervening in all HCC patients and intervening in all HCC patients when the threshold probability was in the range of 0.1 to 0.8.Conclusions The results of this study suggest that for the patients with the risk factors such as preoperative NLR greater than 2.13,PLR greater than 108.15,GGT greater than 46.0 U/L,AFP higher than 18.96 μg/L,tumor size greater than 4.9 cm,and presence of preoperative MVI need to closely pay attention to the postoperative early recurrence.The nomogram predictive model constructed based on these risk factors in this study has a good discrimination and accuracy,and it could obtain clinical net benefit when the threshold probability is 0.1 to 0.8.

hepatocellular carcinomaearly recurrencerisk factornomogram

丛赟、李国煜、王丹妮、邵英梅、吐尔干艾力·阿吉、狄涛

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新疆医科大学第一附属医院肝胆包虫病外科(乌鲁木齐 830054)

新疆医科大学第一附属医院消化血管外科中心(乌鲁木齐 830054)

新疆医科大学第一附属医院皮肤与性病学科(乌鲁木齐 830054)

新疆医科大学省部共建中亚高发病成因与防治国家重点实验室(乌鲁木齐 830054)

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肝细胞癌 早期复发 危险因素 列线图

国家科技重大专项(民口课题)新疆维吾尔自治区高等学校科研计划自然科学研究重点项目省部共建中亚高发病成因与防治国家重点实验室开放基金

2018ZX10301-201-007XJEDU2021I016SKL-HIDCA-2020-BC

2024

中国普外基础与临床杂志
四川大学华西医院

中国普外基础与临床杂志

CSTPCD
影响因子:0.858
ISSN:1007-9424
年,卷(期):2024.31(4)
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