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BCLC 0/A期肝细胞癌根治性切除术后复发评分预警系统的建立及其预测价值分析

刘胜 唐豪佑 杨洋 曾新 黄孝彬 顾秋红 李建水

刘胜, 唐豪佑, 杨洋, 等. BCLC 0/A期肝细胞癌根治性切除术后复发评分预警系统的建立及其预测价值分析[J]. 临床肝胆病杂志, 2021, 37(9): 2113-2119. DOI: 10.3969/j.issn.1001-5256.2021.09.022
引用本文: 刘胜, 唐豪佑, 杨洋, 等. BCLC 0/A期肝细胞癌根治性切除术后复发评分预警系统的建立及其预测价值分析[J]. 临床肝胆病杂志, 2021, 37(9): 2113-2119. DOI: 10.3969/j.issn.1001-5256.2021.09.022
LIU S, TANG HY, YANG Y, et al. Establishment and predictive value of an early warning system for recurrence after radical resection of BCLC stage 0/A hepatocellular carcinoma[J]. J Clin Hepatol, 2021, 37(9): 2113-2119. DOI: 10.3969/j.issn.1001-5256.2021.09.022
Citation: LIU S, TANG HY, YANG Y, et al. Establishment and predictive value of an early warning system for recurrence after radical resection of BCLC stage 0/A hepatocellular carcinoma[J]. J Clin Hepatol, 2021, 37(9): 2113-2119. DOI: 10.3969/j.issn.1001-5256.2021.09.022

BCLC 0/A期肝细胞癌根治性切除术后复发评分预警系统的建立及其预测价值分析

DOI: 10.3969/j.issn.1001-5256.2021.09.022
基金项目: 

四川省南充市科学技术局2019市校合作科研项目 18SXHZ0332

详细信息
    通讯作者:

    李建水,ljs2005doctor@126.com

  • 中图分类号: R735.7

Establishment and predictive value of an early warning system for recurrence after radical resection of BCLC stage 0/A hepatocellular carcinoma

Funds: 

The 2019 Scientific Research Project of City-University Cooperation in Nanchong Bureau of Science & Technology of Sichuan Province 18SXHZ0332

  • 摘要:   目的  建立BCLC 0/A期肝细胞癌(HCC)根治性切除术后复发评分预警系统(PLC-EWSPRS)并对其预测价值进行分析。  方法  回顾性分析川北医学院附属医院2009年1月—2015年1月行根治性切除的232例BCLC 0/A期HCC患者的临床资料。根据电话或门诊资料随访术后5年内是否复发分为复发组(103例)和非复发组(129例)。符合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Mann-Whitney U检验。计数资料两组间采用χ2检验或Fisher精确法检验。将差异具有统计学意义的指标纳入二元logistic回归分析,探讨BCLC 0/A期HCC术后复发的危险因素。将独立危险因素赋值为2分,危险因素赋值为1分,建立PLC-EWSPRS系统。采用受试者工作特征(ROC)曲线下面积(AUC)评估其诊断效能。  结果  两组患者术前AST(Z=3.864, P<0.001)、ALT(Z=4.587, P<0.001)复发组明显高于非复发组,术前Alb(t=-5.628, P<0.001)复发组明显低于非复发组; 复发组HBsAg阳性、包膜侵犯、微血管侵犯(MVI)、肿瘤直径≥5 cm、肝硬化(中重度)、非R0切除、5年死亡数所占比例均显著高于非复发组(χ2值分别为35.539、22.325、13.398、7.130、4.312、4.034、18.527,P值均<0.05)。回归分析显示:术前Alb<40 g/L(OR=5.796,P<0.001)、术前ALT≥40 U/L(OR=3.029,P=0.002)、MVI(OR=3.981,P=0.003)、HBsAg阳性(OR=7.829,P<0.001)、包膜侵犯(OR=5.357,P<0.001)、非R0切除(OR=3.048,P=0.018)均为根治性切除的BCLC 0/A期HCC术后5年复发的独立危险因素。根据PLC-EWSPRS系统拟定的赋分标准,复发组最低分2分,最高分14分; 非复发组最低分0分,最高分11分,复发组分值明显高于非复发组,两组患者分值比较差异具有统计学意义(P<0.05)。ROC曲线分析结果显示,预测根治性切除的BCLC 0/A期HCC者术后5年内复发的AUC(95%CI)为0.918(0.883~0.953),P<0.001;亚组预测低、中、高分数段术后5年内复发的AUC(95%CI)分别为:0.796(0.695~0.896),P=0.002;0.859(0.791~0.927),P<0.001;0.944(0.839~1.000),P=0.044。  结论  PLC-EWSPRS对BCLC 0/A期HCC患者术后5年复发具有良好的预测价值,对根治性切除的BCLC 0/A期HCC患者术后复查及治疗策略的制订具有重要的指导意义。

     

  • 图  1  PLC-EWSPRS预测术后5年复发的ROC曲线

    图  2  PLC-EWSPRS预测术后5年死亡的ROC曲线

    表  1  术后5年内复发组与非复发组相关基线资料、并发症及结局的比较

    项目 复发组(n=103) 非复发组(n=129) 统计值 P
    住院时间(d) 9.84±3.98 10.23±4.72 t=-0.666 0.506
    年龄(岁) 50.36±12.05 52.28±12.99 t=-1.155 0.249
    体质量(kg) 56.94±4.85 56.68±6.70 t=0.337 0.745
    OS(月) 18.0(8.0~31.0) 25.0(15.5~40.5) Z=-2.880 0.004
    术前RBC(109/L) 4.63±0.68 4.53±0.59 t=1.166 0.245
    术前WBC(109/L) 5.57±1.63 5.60±2.02 t=-0.438 0.662
    术前PLT(109/L) 144(101~203) 138(92~200) Z=0.445 0.656
    术前TBil(μmol/L) 14.7(11.7~19.3) 13.6(10.1~18.0) Z=1.666 0.096
    术前DBil(μmol/L) 4.8(3.5~6.4) 4.5(3.6~5.8) Z=0.975 0.330
    术前ALT(U/L) 51(39~63) 39(30~52) Z=4.587 <0.001
    术前AST(U/L) 44(33~65) 34(25~51) Z=3.864 <0.001
    术前Alb(g/L) 39.08±4.19 42.34±4.53 t=-5.628 <0.001
    男性[例(%)] 84(81.6) 102(79.1) χ2=0.222 0.637
    HBsAg阳性[例(%)] 87(84.5) 60(46.5) χ2=35.539 <0.001
    包膜侵犯[例(%)] 48(46.6) 23(17.8) χ2=22.325 <0.001
    肿瘤直径≥5 cm[例(%)] 86(83.5) 88(68.2) χ2=7.130 0.008
    MVI[例(%)] 32(31.1) 15(11.6) χ2=13.398 <0.001
    R0切除[例(%)] 79(76.7) 112(86.8) χ2=4.034 0.045
    低分化程度[例(%)] 40(38.8) 53(41.1) χ2=0.121 0.728
    肿瘤数≥2个[例(%)] 11(10.7) 15(11.6) χ2=0.052 0.820
    5年死亡数[例(%)] 51(49.5) 29(22.5) χ2=18.527 <0.001
    肝硬化(中重度)[例(%)] 34(33.0) 27(20.9) χ2=4.312 0.038
    BCLC分期[例(%)]
      0期 9(8.7) 8(6.2) χ2=0.543 0.461
      A期 94(91.3) 121(93.8)
    并发症[例(%)]
      肺部感染 8(7.8) 8(6.2) χ2=0.219 0.640
      腹腔感染 3(2.9) 2(1.6) 0.841
      腹腔出血 2(1.9) 7(5.4) 0.172
      腹腔积液 81(78.6) 88(68.2) χ2=3.146 0.076
      胸腔积液 9(8.7) 5(3.9) χ2=2.387 0.122
    复发部位[例(%)]
      肝 86(83.5)
      肺 5(4.9)
      肝肺 3(2.9)
      肝脑 1(1.0)
      腹腔 5(4.9)
      骨 1(1.0)
      淋巴结 2(1.9)
    下载: 导出CSV

    表  2  BCLC 0/A期HCC患者行根治性切除术5年复发的logistic单因素分析

    项目 B SE Wald P OR(95%CI)
    术前Alb(<40 g/L) 1.563 0.286 29.804 <0.001 4.774(2.724~8.368)
    术前ALT(≥40 U/L) 1.045 0.278 14.093 <0.001 2.843(1.648~4.906)
    MVI 1.231 0.348 12.551 <0.001 3.425(1.733~6.769)
    HBsAg阳性 1.833 0.324 31.955 <0.001 6.253(3.312~11.806)
    肿瘤直径(≥5 cm) 0.857 0.326 6.921 0.009 2.357(1.244~4.464)
    包膜侵犯 1.392 0.303 21.073 <0.001 4.022(2.220~7.287)
    肝硬化(中重度) 0.621 0.301 4.255 0.039 1.862(1.031~3.360)
    非R0切除 0.694 0.349 3.944 0.047 2.001(1.009~3.970)
    下载: 导出CSV

    表  3  BCLC 0/A期HCC患者行根治性切除术5年复发的logistic多因素分析

    项目 B SE Wald P OR(95%CI)
    常量 -4.598 0.661 48.371 <0.001 0.010
    术前Alb(<40 g/L) 1.757 0.376 21.826 <0.001 5.796(2.773~12.113)
    术前ALT(≥40 U/L) 1.108 0.366 9.175 0.002 3.029(1.479~6.204)
    MVI 1.382 0.463 8.922 0.003 3.981(1.608~9.856)
    HBsAg阳性 2.058 0.413 24.884 <0.001 7.829(3.488~17.574)
    肿瘤直径(≥5 cm) 0.606 0.410 2.187 0.139 1.833(0.821~4.091)
    包膜侵犯 1.678 0.411 16.668 <0.001 5.357(2.393~11.992)
    肝硬化(中重度) 0.406 0.406 1.001 0.317 1.502(0.677~3.329)
    非R0切除 1.115 0.473 5.552 0.018 3.048(1.206~7.704)
    下载: 导出CSV

    表  4  两组患者PLC-EWSPRS评分的分布及复发差异分析

    分值分段(复发率) 分值 各分值病例分布[例(%)] 分值段病例分布[例(%)] χ2 P
    复发组(n=103) 非复发组(n=129) 复发组(n=103) 非复发组(n=129)
    低分段(0~5) 0 0 5(3.9) 91.502 <0.001
    (9.8%) 1 0 15(11.6)
    2 2(1.9) 8(6.2)
    3 2(1.9) 18(14.0)
    4 2(1.9) 18(14.0)
    5 4(3.9) 28(21.7) 10(9.7) 92(71.3)
    中分段(6~10) 6 14(13.6) 16(12.4)
    (68.2%) 7 10(9.7) 14(10.9)
    8 25(24.3) 1(0.8)
    9 12(11.7) 2(1.6)
    10 14(14.6) 2(1.6) 75(72.8) 35(27.1)
    高分段(11~14) 11 2(1.9) 2(1.6)
    (90.0%) 12 8(7.8) 0
    13 6(5.8) 0
    14 2(1.9) 0 18(17.5) 2(1.6)
    下载: 导出CSV
  • [1] BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
    [2] European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis[J]. J Hepatol, 2018, 69(2): 406-460. DOI: 10.1016/j.jhep.2018.03.024.
    [3] TSILIMIGRAS DI, BAGANTE F, SAHARA K, et al. Prognosis after resection of Barcelona Clinic Liver Cancer (BCLC) stage 0, A, and B hepatocellular carcinoma: A comprehensive assessment of the current BCLC classification[J]. Ann Surg Oncol, 2019, 26(11): 3693-3700. DOI: 10.1245/s10434-019-07580-9.
    [4] FORNER A, LLOVET JM, BRUIX J. Hepatocellular carcinoma[J]. Lancet, 2012, 379(9822): 1245-1255. DOI: 10.1016/S0140-6736(11)61347-0.
    [5] YANG WS, ZENG XF, LIU ZN, et al. Diet and liver cancer risk: A narrative review of epidemiological evidence[J]. Br J Nutr, 2020, 124(3): 330-340. DOI: 10.1017/S0007114520001208.
    [6] XU W, LIU F, SHEN X, et al. Prognostic nomograms for patients with hepatocellular carcinoma after curative hepatectomy, with a focus on recurrence timing and post-recurrence management[J]. J Hepatocell Carcinoma, 2020, 7: 233-256. DOI: 10.2147/JHC.S271498.
    [7] LIU YW, YONG CC, LIN CC, et al. Liver resection of hepatocellular carcinoma within and beyond the Barcelona Clinic Liver Cancer guideline recommendations: Results from a high-volume liver surgery center in East Asia[J]. J Surg Oncol, 2020, 122(8): 1587-1594. DOI: 10.1002/jso.26183.
    [8] TSILIMIGRAS DI, BAGANTE F, MORIS D, et al. Recurrence patterns and outcomes after resection of hepatocellular carcinoma within and beyond the barcelona clinic liver cancer criteria[J]. Ann Surg Oncol, 2020, 27(7): 2321-2331. DOI: 10.1245/s10434-020-08452-3.
    [9] KABIR T, SYN N, RAMKUMAR M, et al. Effect of surgical delay on survival outcomes in patients undergoing curative resection for primary hepatocellular carcinoma: Inverse probability of treatment weighting using propensity scores and propensity score adjustment[J]. Surgery, 2020, 167(2): 417-424. DOI: 10.1016/j.surg.2019.09.022.
    [10] Medical Administration of the National Health Commission of the people's Republic of China. Guidelines for diagnosis and treatment of primary liver cancer in China (2019 edition)[J]. J Clin Hepatol, 2020, 36(2): 277-292. DOI: 10.3969/j.issn.1001-5256.2020.02.007.

    中华人民共和国国家卫生健康委员会政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 临床肝胆病杂志, 2020, 36(2): 277-292. DOI: 10.3969/j.issn.1001-5256.2020.02.007.
    [11] YANG F, MA L, YANG Y, et al. Contribution of hepatitis B virus infection to the aggressiveness of primary liver cancer: A clinical epidemiological study in Eastern China[J]. Front Oncol, 2019, 9: 370. DOI: 10.3389/fonc.2019.00370.
    [12] WANG S, WU QW, LI XK, et al. Interpretation of guidelines for diagnosis and treatment of primary liver cancer in China (2019 edition)[J]. J Clin Hepatol, 2020, 36(5): 996-999. DOI: 10.3969/j.issn.1001-5256.2020.05.009.

    王姗, 吴庆旺, 李小科, 等. 《原发性肝癌诊疗规范(2019年版)》解读[J]. 临床肝胆病杂志, 2020, 36(5): 996-999. DOI: 10.3969/j.issn.1001-5256.2020.05.009.
    [13] WU JC, HUANG YH, CHAU GY, et al. Risk factors for early and late recurrence in hepatitis B-related hepatocellular carcinoma[J]. J Hepatol, 2009, 51(5): 890-897. DOI: 10.1016/j.jhep.2009.07.009.
    [14] WANG B, XIA CY, LAU WY, et al. Determination of clonal origin of recurrent hepatocellular carcinoma for personalized therapy and outcomes evaluation: A new strategy for hepatic surgery[J]. J Am Coll Surg, 2013, 217(6): 1054-1062. DOI: 10.1016/j.jamcollsurg.2013.07.402.
    [15] KIM JM, KWON CH, JOH JW, et al. Intrahepatic metastasis is more risky than multiple occurrence in hepatocellular carcinoma patients after curative liver resection[J]. Hepatogastroenterology, 2015, 62(138): 399-404. DOI: 10.5754/hge131006.
    [16] LIN S, YE F, RONG W, et al. Nomogram to assist in surgical plan for hepatocellular carcinoma: A prediction model for microvascular invasion[J]. J Gastrointest Surg, 2019, 23(12): 2372-2382. DOI: 10.1007/s11605-019-04140-0.
    [17] ZHANG X, LI J, SHEN F, et al. Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma[J]. J Gastroenterol Hepatol, 2018, 33(2): 347-354. DOI: 10.1111/jgh.13843.
    [18] ROAYAIE S, BLUME IN, THUNG SN, et al. A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma[J]. Gastroenterology, 2009, 137(3): 850-855. DOI: 10.1053/j.gastro.2009.06.003.
    [19] ERSTAD DJ, TANABE KK. Prognostic and therapeutic implications of microvascular invasion in hepatocellular carcinoma[J]. Ann Surg Oncol, 2019, 26(5): 1474-1493. DOI: 10.1245/s10434-019-07227-9.
    [20] REGIMBEAU JM, ABDALLA EK, VAUTHEY JN, et al. Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: Results of a multicenter study[J]. J Surg Oncol, 2004, 85(1): 36-41. DOI: 10.1002/jso.10284.
    [21] LAFARO K, GRANDHI MS, HERMAN JM, et al. The importance of surgical margins in primary malignancies of the liver[J]. J Surg Oncol, 2016, 113(3): 296-303. DOI: 10.1002/jso.24123.
    [22] HU W, HUANG S, DONG L, et al. MDR1 gene polymorphism correlated with pathological characteristics and prognosis in patients with primary hepatocellular carcinoma receiving interventional therapy[J]. Anticancer Drugs, 2019, 30(3): 233-240. DOI: 10.1097/CAD.0000000000000680.
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