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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 57 -60. doi: 10.3877/cma.j.issn.1674-3946.2021.01.017

所属专题: 文献

论著

原发性肝细胞癌微血管侵犯的术前预测模型构建及临床意义
于洁1, 段红亮1,(), 吴晓庆2, 兰琳2, 靳稳妮2, 高秋英3   
  1. 1. 712000 西安,陕西省核工业215医院普外科
    2. 710061 西安,西安市第八医院
    3. 710068 西安,陕西省人民医院
  • 收稿日期:2020-05-07 出版日期:2021-02-10
  • 通信作者: 段红亮

Construction and verification of preoperative prediction model for microvascular invasion of primary hepatocellular carcinoma

Jie Yu1, Hongliang Duan1,(), Xiaoqing Wu2, Lin Lan2, Wenni Jin2, Qiuying Gao3   

  1. 1. Department of General Surgery, 215 Hospital of Shaanxi Provincial Nuclear Industry, Shaanxi 712000, China
    2. The Eighth Hospital of Xi’an city, Shaanxi 710061, China
    3. Shaanxi Provincial People’s Hospital, Shaanxi 710068, China
  • Received:2020-05-07 Published:2021-02-10
  • Corresponding author: Hongliang Duan
  • Supported by:
    Shaanxi provincial project of key research and development plan(2019SF-007); Social Development Science and Technology Project of Shaanxi Province(2015SF065)
引用本文:

于洁, 段红亮, 吴晓庆, 兰琳, 靳稳妮, 高秋英. 原发性肝细胞癌微血管侵犯的术前预测模型构建及临床意义[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(01): 57-60.

Jie Yu, Hongliang Duan, Xiaoqing Wu, Lin Lan, Wenni Jin, Qiuying Gao. Construction and verification of preoperative prediction model for microvascular invasion of primary hepatocellular carcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(01): 57-60.

目的

构建原发性肝细胞癌(HCC)微血管侵犯(MVI)的术前预测模型并验证其准确性。

方法

回顾性分析2017年1月至2019年6月行肝切除术的160例HCC患者的临床病理资料,观察患者MVI情况。采用SPSS20.0软件对数据进行处理分析,计数资料采用χ2检验;计量资料采用t检验;采用单因素和多因素Logistic回归分析影响MVI的独立危险因素,并构建HCC患者MVI的术前预测模型,通过描绘受试者工作特征曲线(ROC)并计算曲线下面积(AUC)从而来评估模型的预测能力,并以术后病理诊断结果为金标准对预测模型进行验证。

结果

在160例患者中,有MVI者86例,无MVI者74例。对单因素分析有统计学意义的资料进行Logistic多因素分析,结果显示:肿瘤直径、瘤周低回声晕环、甲胎蛋白(AFP)水平、血小板与淋巴细胞比值(PLR)水平、循环肿瘤DNA(ctDNA)浓度是HCC的MVI独立危险因素。根据Logistic回归分析各变量的回归系数构建预测模型,通过绘制ROC曲线,计算出AUC值为0.914(95%CI 0.820~0.962),当最佳临界值为0.069时对HCC患者MVI具有预测价值,灵敏度为86.5%,特异度为87.9%,约登指数为0.74。以术后病理诊断为金标准,验证预测模型,灵敏度为88.4%,特异度为93.2%,两者灵敏度和特异度无统计学差异(P>0.05)。

结论

基于Logistic多因素回归分析建立预测模型具有较高的灵敏度和特异性,对HCC微血管侵犯的患者具有较高的预测价值,可为HCC患者的术前治疗方案、手术规划提供参考。

Objective

To construct a preoperative predictive model of primary hepatocellular carcinoma (HCC) microvascular invasion (MVI) and to verify its accuracy.

Methods

The clinicopathological data of 160 HCC patients underwent hepatectomy from January 2017 to June 2019 were analyzed retrospectively to observe the MVI status of the patients. SPSS20.0 software was used to process and to analyze the data. Count data were examined by using χ2 test; measurement data were examined by using independent t test; Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors affecting MVI, and to construct a preoperative predictive model of primary hepatocellular carcinoma MVI. To evaluate the predictive ability of the model and verify the predictive model with the postoperative pathological diagnosis results as the gold standard.

Results

Among 160 patients, 86 had MVI and 74 had no MVI. Logistic multivariate regression analysis of statistically significant clinical pathology data from single factor analysis showed that tumor diameter, peritumoral hypoechoic halo, alpha-fetoprotein (AFP) level, platelet-to-lymphocyte ratio (PLR) level, and circulating tumor DNA (ctDNA) concentration were independent risk factors for primary hepatocellular carcinoma MVI. According to the logistic regression analysis of the regression coefficients of each variable to construct a prediction model, by drawing the ROC curve, the AUC value was calculated to be 0.914 (95% CI 0.820-0.962). When the optimal cut-off value is 0.069, it has predictive value for primary hepatocellular carcinoma MVI. The sensitivity is 86.5%, the specificity is 87.9%, and the Youden index is 0.74. Using the postoperative pathological diagnosis as the gold standard to verify the prediction model, the sensitivity was 88.4% and the specificity was 93.2%. There was no statistical difference in sensitivity and specificity between them (P>0.05).

Conclusion

The establishment of a prediction model based on Logistic multi-factor regression analysis has a high sensitivity and specificity, and has a high predictive value for patients with primary hepatocellular carcinoma microvascular invasion, It could provide reference for the preoperative treatment plan and surgical planning of hepatocellular carcinoma patients.

图1 HE染色肝癌组织病理结果[注:(A)肝癌组织(肿瘤微血管浸润周围基质,侵犯至癌周交界处汇管区纤维组织内,HE×400倍);(B)肝癌组织(HE×100倍)]
表1 160例肝癌患者病理特征与MVI单因素分析[例(%)]
表2 原发性肝细胞癌MVI的Logistic多因素回归分析
图2 160例原发性肝细胞癌MVI术前预测模型ROC曲线
表3 原发性肝细胞癌MVI术前预测模型相关变量赋值
表4 160例肝癌患者IMA根部淋巴结转移的术前预测模型结果
[1]
王宁,刘硕,杨雷,等.2018全球癌症统计报告解读[J/CD].肿瘤综合治疗电子杂志,2019,5(1): 87-97.
[2]
丛文铭,步宏,陈杰,等.原发性肝癌规范化病理诊断指南(2015年版)[J].临床肝胆病杂志,2015,31(6): 833-839.
[3]
Xiao L, Zeng F, Deng GT.Commentary on: Nomograms based on inflammatory biomarkers for predicting tumor grade and microvascular invasion in stage I/II hepatocellular carcinoma[J]. Biosci Rep,2019,39(10): BSR20190683.
[4]
陈孝平,裴有亮,张万广.腹腔镜肝癌根治术的热点与未来发展[J/CD].中华普外科手术学杂志(电子版),2019,13(3): 217-219.
[5]
Zhu Y, Xu D, Zhang Z,et al.A new laboratory-based algorithm to predict microvascular invasion and survival in patients with hepatocellular carcinoma[J]. Int J Surg,2018,57: 45-53.
[6]
Erstad DJ, Tanabe KK.ASO Author Reflections: A New Look at the Clinical Significance of MVI in Hepatocellular Carcinoma[J].Ann Surg Oncol,2019,26(Suppl 3): 617-618.
[7]
鲁海珍. 肝细胞肝癌微血管侵犯病理解读[J/CD]. 肝癌电子杂志,2018,2: 13-15.
[8]
Huang MQ, Liao B, Xu P,et al.Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation[J].Contrast Media Mol Imaging,2018, 2018: 9674565.
[9]
Lee S, Kim SH, Lee JE,et al.Preoperative Gadoxetic acid-enhanced MRI for Predicting Microvascular Invasion in Patients with Single hepatocellular carcinoma[J]. J Hepatol,2017, 67(3): 526-534.
[10]
Toader E, Bancu A, Mitrica DE,et al.Interrelations between elevated alpha-fetoprotein levels and tumor morphology of patients with hepatocellular carcinoma[J].Rom J Morphol Embryol,2019,60(1): 181-187.
[11]
Wojtukiewicz MZ, Sierko E, Hempel D,et al.Platelets and cancer angiogenesis nexus[J].Cancer Metastasis Rev,2017,36(2): 249-262.
[12]
Zhao Y, Si G, Zhu F,et al.Prognostic role of platelet to lymphocyte ratio in hepatocellular carcinoma: a systematic review and meta-analysis[J].Oncotarget, 2017,8(14): 22854-22862.
[13]
杜培源,宋京海,乔江春,等. 肝细胞癌患者微血管侵犯影响因素分析[J]. 中华肝胆外科杂志,2019, 25(1): 26-29.
[14]
Piscaglia F, Svegliati-Baroni G, Barchetti A,et al.Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study[J].Hepatology,2016,63(3): 827-838.
[15]
陈衍辉,王雅婷,杨博航,等. 循环肿瘤DNA在肝癌分子检测中的应用及研究进展[J/CD]. 肝癌电子杂志,2017,2: 32-36.
[16]
丁巍,贾春花. 原发性肝癌术后外周血循环肿瘤DNA的临床意义[J]. 临床血液学杂志(输血与检验),2020,2: 245-247,252.
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