摘要
目的 探讨Ishak炎症评分系统和肝细胞癌（HCC）患者临床病理学特征与根治性肝切除术后复发的关系,并建立Nomogram术后复发预测模型.方法 收集2006年1月至2009年12月重庆医科大学附属第一医院肝胆外科收治的326例接受根治性肝切除术的HCC患者病例资料作为研究组,2010年1月至2012年12月收治的110例HCC患者资料作为验证组.利用研究组的随访资料和癌旁组织Ishak炎症评分建立Nomogram复发预测模型,通过验证组对模型预测的准确性进行验证.采用Kaplan-Meier进行单因素生存分析,有统计学意义的指标进一步纳入Cox比例风险回归模型进行多因素生存分析;采用受试者工作特征曲线（ROC）检测模型预测的准确性.结果 根据患者癌旁组织Ishak炎症评分,将患者分为4级：Ⅰ级（1～4分）,Ⅱ级（5～8分）,Ⅲ级（9～12分）和Ⅳ级（13～18分）.Ishak炎症评分与患者的AST（中位数36.0 U/L,P=0.011）、γ-谷氨酰转肽酶（中位数54.5 U/L,P=0.005）、HBV-DNA定量（20.5％〉106拷贝数/ml,P=0.015）和微血管侵犯（26.7％阳性,P=0.021）有关.多因素分析结果显示,患者的癌旁Ishak炎症评分（P=0.007）、HNB-DNA定量（P〈0.01）、肿瘤最大径（P=0.001）和微血管侵犯（P=0.001）与HCC患者的复发有关.将上述四个指标纳入Nomogram复发预测模型.校准曲线显示,预测复发和实际复发有较高的一致性.C指数和ROC曲线下面积分析结果显示,Nomogram预测能力明显高于AJCC和BCLC临床分期的预测能力.验证组的结果与实验组结果基本一致.结论 基于Ishak炎症评分构建的Nomogram能够预测HCC的复发,可能有助于HCC患者术后复发的监测.
Objective To investigate the correlation between Ishak inflammation score and the clinicopathological characteristics and recurrence of patients with hepatocellular carcinoma （ HCC ） after curative resection,and then set up a recurrence nomogram for HCC. Methods A total of 326 patients with HCC after curative resection from January 2006 to December 2009 were studied retrospectively as training cohort and 110 HCC patients after surgery from January 2010 to December 2012 were used as validation cohort. Clinical follow-up data and peritumoral Ishak inflammation score in training cohort were used to set up a nomogram predicting recurrence of HCC,which was verified by validation cohort. Kaplan-Meier and Cox proportional hazard regression model were used to analyzed accuracy of model prediction. Results According to Ishak inflammation score,patients were divided into four subgroups：Grade Ⅰ（1-4 scores）, Grade Ⅱ（5-8 scores）,Grade Ⅲ （9-12 scores） and Grade Ⅳ（13-18 scores）. Ishak inflammation score were associated with aspartate transaminase （ median 36. 0 U/L, P= 0. 011 ） ,γ-glutamyl transpeptidase （median 54. 5 U/L,P=0. 005）,HBV-DNA load（20. 5%〉106 copies/ml,P=0. 015） and microvascular invasion（ 26. 7% positive, P=0. 021） . Multivariate analysis showed that Ishak inflammation score （ P=0. 007）,HBV-DNA load（P〈0. 01）,tumor size（P=0. 001） and microvascular invasion（P=0. 001） were related with the recurrence of HCC patients. These four risk factors were incorporated into the nomogram. Calibration curves of the nomogram had good agreement between prediction and observation in the probability of recurrence. Both C-indexes and receiver operating characteristic curve analyses revealed that this nomogram had better predictive abilities than those of the AJCC and Barcelona Clinic Liver Cancer （ BCLC） stage systems. These results were verified by the validation cohort. Conclusion A nomogram based on Ishak inflammation score could accurately predict the recurrenc
出处
《中华外科杂志》
CAS
CSCD
北大核心
2018年第2期124-129,共6页
Chinese Journal of Surgery
基金
国家临床重点专科建设项目（2012-649）
国家自然科学基金资助项目（81301656,81703063）
重庆市渝中区科委基础与前沿研究计划项目（20140109）
关键词
肝细胞癌
炎症
NOMOGRAM
手术
复发
Hepatocellular carcinoma
Inflammation
Nomogram
Surgery
Recurrence
