微波消融联合经导管动脉化疗栓塞术治疗肝细胞癌生存预测

目的探讨影响微波消融(MWA)联合TACE治疗肝细胞癌(HCC)患者总生存期(OS)的预测因素,并对患者OS进行有效预测。方法回顾性分析2013年1月至2017年3月行MWA联合TACE治疗的HCC患者59例。以OS为基础,针对13项潜在因素,采用单因素分析(Log-rank检验)及Cox多因素回归分析探讨影响OS的预测因素,并采用R软件构建预后列线图(nomogram)以预测OS,使用Harrell’s c statistic评价其准确性。结果59例患者的中位OS(mOS)为(24.0±11.6)个月,中位肿瘤进展时间为(10.3±5.9)个月。单因素分析及Cox多因素回归分析显示门静脉癌栓(PVTT)、甲胎蛋白(AFP)≥400 ng/mL、最大肿瘤直径≥7 cm是影响OS的预测因素。预后计算图(nomogram)的准确度评价Harrell’s c statistic为0.81。结论PVTT、AFP≥400 ng/mL、最大肿瘤直径≥7 cm是影响MWA联合TACE治疗HCC患者OS的预测因素,预后计算图可准确预测患者的OS。

The survival prediction for HCC patients receiving microwave ablation combined with TACE

Objective To investigate the factors for predicting the total survival(OS) time in hepatocellular carcinoma(HCC) patients who receive microwave ablation(MWA)combined with transcatheter arterial chemoembolization(TACE) treatment, and to establish a model used for accurately predicting OS of HCC patients. Methods The clinical data of 59 HCC patients, who received MWA combined with TACE during the period from January 2013 to July 2017, were retrospectively analyzed. Univariate analysis(Log-rank test)and multivariate Cox regression analysis were used to analyze thirteen potential factors which might affect the OS, and the factors for predicting OS were discussed. Using R software a prognostic nomogram was established to predict the OS, and Harrell’s c statistic was used to evaluate its accuracy. Results The mean OS was(24.0±11.6) months and the median tumor progression time was(10.3±5.9) months. Univariate analysis and multivariate Cox regression analysis indicated that the portal vein tumor thrombosis(PVTT), the AFP level≥400 ng/mL and the largest tumor diameter≥7 cm were the reliable factors for predicting the OS. The prognostic nomogram accuracy, which was evaluated by Harrell’s c statistics, was 0.81. Conclusion PVTT,AFP≥400 ng/mL and the largest tumor diameter ≥7 cm are valuable factors for predicting the OS in HCC patients receiving MWA and TACE treatment. The prognostic nomogram can accurately predict the OS of patients.