摘要
目的:构建乙型病毒性肝炎相关性肝细胞癌患者肝切除术后感染列线图并对其进行评估。方法:回顾性分析2014年1月至2022年12月在天津市第三中心医院肝胆外科实施肝切除手术的肝细胞癌患者资料。共入组229例患者,其中男性174例,女性55例,年龄(58.2±11.4)岁。LASSO回归筛选乙型病毒性肝炎相关性肝细胞癌肝切除术后感染的相关因素,进一步纳入多因素logistic回归分析。基于多因素logistic回归分析的结果建立预测术后感染的列线图。利用一致性指数(C-index)、校准曲线及受试者工作特征(ROC)曲线评估模型,用决策曲线分析该模型的临床适用性。采用bootstrap自抽样法对模型进行内部验证。结果:使用LASSO回归筛选术后感染发生的相关因素,共筛选出9个变量,分别为性别、吸烟史、体质量指数、甲胎蛋白、手术切除方式(非解剖性/解剖性)、术中出血量、手术方式(腹腔镜/开腹)、血肌酐和术后胆瘘。多因素logistic回归分析,体质量指数、手术切除方式、术中出血量>500 ml和术后胆瘘是术后感染的危险因素(均 P<0.05)。基于上述危险因素构建乙型病毒性肝炎相关性肝细胞癌肝切除术后感染列线图,C-index为0.839(95% CI:0.768~0.910),ROC曲线下面积为0.853(95% CI:0.795~0.912),该模型具有良好的预测能力。校准曲线与理想曲线基本吻合。决策曲线分析该模型具有良好的临床适用性。内部验证的C-index为0.829(95% CI:0.766~0.892)。 结论:基于体质量指数、手术切除方式、术中出血量>500 ml和术后胆瘘构建的乙型病毒性肝炎相关性肝细胞癌肝切除术后感染列线图具有较高的预测准确度,可用于术后感染的预测。
Objective To develop and validate a postoperative infection nomogram of hepatitis B-associated hepatocellular carcinoma(HCC)after hepatectomy.MethodsClinical data of 229 patients with HCC undergoing hepatectomy at the Department of Hepatobiliary Surgery of Tianjin Third Central Hospital from January 2014 to December 2022 were retrospectively analyzed,including 174 males and 55 females,aged(58.2±11.4)years.LASSO regression analysis screened the factors associated with hepatitis B-associated HCC infection after hepatectomy,which were further incorporated into multivariate logistic regression analysis.A nomographic prediction model was established based on the results of multivariate logistic regression analysis.Concordance index(C-index),calibration curve and receiver operating characteristic(ROC)curve were used to evaluate the model,and decision curve analysis(DCA)was used to analyze the clinical applicability of the model.Internal validation of the model was performed using bootstrap method.ResultsA total of nine variables were screened as factors associated with the postoperative infections using LASSO regression,including gender,smoking history,body mass index(BMI),serum level of alpha fetoprotein,resection fashion(anatomical or non-anatomical),intraoperative blood loss,surgical method(laparoscopy or open),serum level of creatinine,and postoperative biliary fistula.Multivariate logistic regression analysis showed that BMI,resection fashion,intraoperative blood loss>500 ml,and postoperative biliary fistula were risk factors for postoperative infection(all P<0.05).Based on the above risk factors,a postoperative infection nomogram of hepatitis B-associated HCC after hepatectomy was established.The C-index was 0.839(95%CI:0.768-0.910),and the area under ROC curve was 0.853(95%CI:0.795-0.912),indicating that the model had a good predictive ability.The calibration curve was basically consistent with the ideal curve.The DCA showed that the model had a good clinical applicability.Internal validation C-index was 0.829(
作者
谭兵
马亚楠
于珍
任超逸
张健东
Tan Bing;Ma Yanan;Yu Zhen;Ren Chaoyi;Zhang Jiandong(Department of Laboratory Medicine,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Tianjin Artificial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Hepatobiliary Surgery,Tianjin Third Central Hospital,Tianjin 300170,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2024年第1期21-26,共6页
Chinese Journal of Hepatobiliary Surgery
基金
天津市科技计划项目(22JCQNJC01590)
天津市医学重点学科(专科)建设项目(TJYXZDXK-047A)。
关键词
乙型肝炎病毒
癌
肝细胞
列线图
术后感染
Hepatitis B virus
Carcinoma,hepatocellular
Nomograms
Postoperative infection
