基于术前人B-淋巴细胞趋化因子1检测的肝细胞癌患者肝切除术后复发预测模型的构建及分析

目的探究与肝细胞癌患者肝切除术后复发相关的血清学指标,构建复发预后模型以评估患者是否适合采用姑息性肝切除手术。方法共纳入了2009年2月—2013年7月于郑州大学附属肿瘤医院接受肝切除术并进行随访的肝细胞癌患者111例。收集患者的基本资料,根据患者在随访期间内是否复发分为复发组和未复发组。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ²检验。Kaplan-Meier法绘制生存曲线,log-rank检验比较差异。单因素与多因素分析采用Cox回归分析,采用受试者工作特征曲线(ROC曲线)判断预测效能。结果Kaplan-Meier生存曲线显示AFP、ALP、GGT、FIB低值组及人B-淋巴细胞趋化因子1(CXCL13)高值组患者的中位复发时间更长(P值均<0.05)。AFP[HR(95%CI)=1.69(1.03~2.79),P=0.039]、GGT[HR(95%CI)=1.89(1.14~3.14),P=0.014]和CXCL13[HR(95%CI)=0.54(0.33~0.89),P=0.015]为与肝切除术后复发相关的独立因素。基于其构成的预后指数:PI=0.526×AFP+0.637×GGT-0.616×CXCL13,预测姑息性切除术后0~3个月内复发的ROC曲线下面积(AUC)为0.87,灵敏度为93.75%,特异度为63.64%,但对0~6个月(AUC=0.68)及更长时间的预测效能明显下降,对姑息性切除的复发预测效能显著高于根治性切除。结论基于CXCL13、AFP和GGT构建的预后模型可用于评估患者采用姑息性肝切除术后的早期复发风险,有助于临床医生依据患者获益情况作出诊疗决策。

Construction and analysis of a predictive model for posthepatectomy recurrence in patients with hepatocellular carcinoma based on preoperative CXCL13 measurement

Objective To investigate the serological markers associated with posthepatectomy recurrence in patients with hepatocellular carcinoma,and to establish a prognostic model to evaluate whether palliative hepatectomy is suitable for such patients.Methods A total of 111 patients with hepatocellular carcinoma who underwent hepatectomy in the Affiliated Cancer Hospital of Zhengzhou University from February 2009 to July 2013 and received follow-up were enrolled.Basic clinical data were collected and the patients were divided into recurrence group and non-recurrence group according to whether recurrence was observed during follow-up.The t-test was used for comparison of normally distributed continuous data between two groups and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.Survival curves were plotted using the Kaplan-Meier method,and survival differences were analyzed using the log-rank test.A Cox regression analysis was used to perform univariate and multivariate analyses,and the area under the ROC curve(AUC)was used to evaluate prediction efficiency.Results The Kaplan-Meier survival curves showed that the patients with low alpha-fetoprotein(AFP),alkaline phosphatase,gamma-glutamyl transpeptidase(GGT),and fibrinogen and high CXCL13 had a longer median time to recurrence(P<0.05).AFP(hazard ratio[HR][95%CI]=1.69(1.03~2.79),P=0.039),GGT(HR[95%CI]=1.89(1.14~3.14),P=0.014),and CXCL13(HR[95%CI]=0.54(0.33~0.89),P=0.015)were independent factors associated with posthepatectomy recurrence.The prognostic index PI=0.526×AFP+0.637×GGT-0.616×CXCL13 established based on these factors had an AUC of 0.87,a sensitivity of 93.75%,and a specificity of 63.64%in predicting recurrence within 0-3 months after palliative hepatectomy,with a significant reduction in prediction efficiency for recurrence within 0-6 months(AUC=0.68)or a longer period of time.The recurrence prediction efficiency of this model for palliative hepatectomy was significantly higher than that for radical resection.Conclusion The prognostic model established based on CXCL13,AFP,and GGT can be used to evaluate the risk of early recurrence after palliative hepatectomy and thus helps clinicians to make diagnosis and treatment decisions based on patients’benefits.