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基于超声造影LI-RADS特征的肝细胞癌微血管侵犯列线图模型的构建及验证

奚静 顾美琴 包作伟

引用本文:
Citation:

基于超声造影LI-RADS特征的肝细胞癌微血管侵犯列线图模型的构建及验证

DOI: 10.3969/j.issn.1001-5256.2022.11.016
基金项目: 

江苏省卫生健康委2019年度医学科研面上项目 H201982

伦理学声明:本研究方案于2016年12月17日经由江苏大学附属武进医院伦理委员会审批,批号:2016-P2-010,所纳入患者均签署知情同意书。
利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:奚静负责课题设计,资料分析,撰写论文;顾美琴、包作伟参与收集数据,修改论文。
详细信息
    通信作者:

    顾美琴,gu8210mq@126.com

Construction and validation of a nomogram model for microvascular invasion in hepatocellular carcinoma based on the characteristics on contrast-enhanced ultrasound Liver Imaging Reporting and Data System

Research funding: 

2019 General Medical Research Project of Jiangsu Provincial Health Commission H201982

More Information
  • 摘要:   目的  基于肝细胞癌(HCC)患者的超声造影(CEUS)肝脏成像报告和数据系统(LI-RADS)特征建立预测微血管侵犯(MVI)的列线图模型并进行验证。  方法  选取2017年1月—2020年7月在江苏大学附属武进医院确诊的HCC患者共262例,按照1∶ 1比例随机分为建模组和验证组各131例,以术后镜下病理结果确诊MVI,其中建模组MVI 70例和验证组MVI 56例。采用超声造影评估两组的LI-RADS特征。两组间计量资料比较采用独立样本t检验;两组间计数资料比较采用χ2检验。采用单因素和多因素Logistic回归分析筛选建模组MVI的危险因素;绘制受试者工作特征曲线(ROC曲线),计算模型预测MVI的曲线下面积(AUC),评估预测准确度;应用决策曲线分析模型的一致性,比较模型预测MVI的校正曲线与标准曲线的离散度。  结果  建模组与验证组患者的临床资料和CEUS检查结果比较,差异均无统计学意义(P值均>0.05)。单因素分析显示,与MVI阴性患者相比,MVI阳性患者血清AFP水平显升高,肿瘤直径增大,LI-RADS显示LR-5“后出”和LR-M“先出”增多,LI-RADS分级较高,差异均有统计学意义(P值均<0.05)。多因素分析显示,AFP 20~400 ng/mL(OR=2.65,P<0.001)、AFP≥400 ng/mL(OR=3.98,P<0.001)、肿瘤直径≥30 mm(OR=2.12,P<0.001)和CEUS显示LR-M(OR=3.24,P<0.001) 是MVI的独立危险因素。ROC曲线显示,列线图预测建模组和验证组MVI的AUC分别为0.867和0.821。列线图模型的一致性指数C-Index为0.765(95%CI:0.701~0.834)。在建模组和验证组,列线图模型的预测校准曲线与标准曲线均接近。  结论  利用CEUS得出LI-RADS,并结合AFP和肿瘤直径建立的列线图模型有较好的应用价值,有助于指导临床术前筛选MVI高危患者,制订恰当的手术方案。

     

  • 图  1  HCC的CEUS图像分析

    注:a,肝硬化患者超声显示肿瘤直径35.5 mm,低回声(虚线处);b,MVI阴性,LR-5动脉期增强和“后出”征象(虚线处);c,MVI阳性,LR-M边缘增强和“先出”征象(虚线处);d,病理标本显示分化良好,无MVI (HE染色,×100)。

    Figure  1.  CEUS image of HCC

    图  2  MVI的列线图模型

    Figure  2.  Nomograph model of MVI

    图  3  列线图模型预测建模组和验证组MVI的ROC曲线分析

    注:a,建模组;b,验证组。

    Figure  3.  ROC analysis of nomograph model for predicting MVI in model group and validation group

    图  4  建模组与验证组的列线图预测曲线

    注:a,建模组;b,验证组。

    Figure  4.  Nomograph predictive curve of model group and validation group

    表  1  建模组与验证组的临床资料和CEUS特征比较

    Table  1.   Comparison of clinical datas and CEUS characteristics between model group and validation group

    指标 建模组(n=131) 验证组(n=131) 统计值 P
    男/女(例) 78/53 70/61 χ2=0.994 0.319
    年龄(岁) 58.2±6.7 57.2±6.3 t=1.052 0.198
    乙型肝炎[例(%)] 115(87.8) 110(84.0) χ2=0.787 0.375
    肝硬化[例(%)] 80(61.1) 84(64.1) χ2=0.261 0.610
    肿瘤TNM分期[例(%)] χ2=0.138 0.710
      Ⅰ~Ⅱ 60(45.8) 63(48.1)
      Ⅲ~Ⅳ 71(54.2) 68(51.9)
    分化级别[例(%)] χ2=0.245 0.621
      低 65(49.6) 61(46.6)
      中高 66(50.4) 70(53.4)
    MVI[例(%)] 70(53.4) 56(42.7) χ2=2.997 0.083
    血生化指标
      PT>14 s[例(%)] 42(32.1) 33(25.2) χ2=1.513 0.219
      AFP(ng/mL) 365±74 349±68 t=0.795 0.302
      PLT(×109/L) 201±32 212±39 t=0.632 0.348
      TBil(μmol/L) 15.6±3.8 13.9±3.2 t=0.469 0.521
      Alb(g/L) 35.9±4.5 33.2±4.3 t=0.396 0.627
      ALT(U/L) 40.2±5.3 43.9±5.7 t=0.559 0.501
    二维超声
      肿瘤直径≥30 mm[例(%)] 92(70.2) 81(61.8) χ2=2.059 0.151
    回声类型[例(%)] χ2=0.177 0.674
      低 95(72.5) 98(74.8)
      等或高 36(27.5) 33(25.2)
    边缘不清[例(%)] 101(77.1) 93(71.0) χ2=1.271 0.260
    不规则外形[例(%)] 92(70.2) 94(71.8) χ2=0.074 0.785
    Halo征[例(%)] 32(24.4) 28(21.4) χ2=0.346 0.556
    血管分布[例(%)] χ2=0.078 0.780
      少 97(74.0) 95(72.5)
      多 34(26.0) 36(27.5)
    CEUS特征[例(%)]
      LR-5动脉期增强 93(71.0) 89(67.9) χ2=0.288 0.592
      “后出”征象 57(43.5) 51(38.9) χ2=0.567 0.451
      LR-M边缘增强 19(14.5) 22(16.8) χ2=0.260 0.610
      “先出”征象 78(59.5) 71(54.2) χ2=0.762 0.383
    LI-RADS分级[例(%)] χ2=0.492 0.782
      3~4 16(12.3) 19(14.5)
      5 48(36.6) 50(38.2)
      M 67(51.1) 62(47.3)
    镶嵌图形征[例(%)] 23(17.6) 25(19.1) χ2=0.102 0.749
    结节内结节征[例(%)] 20(15.3) 17(13.0) χ2=0.283 0.595
    下载: 导出CSV

    表  2  MVI的危险因素分析

    Table  2.   Risk factor analysis of MVI

    因素 单因素分析 多因素分析
    OR 95%CI P OR 95%CI P
    AFP
    20~400 ng/mL 3.19 2.66~3.42 <0.001 2.65 2.13~3.23 <0.001
    ≥400 ng/mL 4.45 3.78~4.79 <0.001 3.98 3.32~4.39 <0.001
    肿瘤直径≥30 mm 2.76 2.23~3.16 <0.001 2.12 1.69~2.58 <0.001
    LR-5“后出” 2.09 1.56~2.54 <0.001
    LR-M“先出” 3.96 3.46~4.49 <0.001 3.24 2.78~3.65 <0.001
    LI-RADS分级 2.01 1.48~2.43 <0.001
    下载: 导出CSV
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  • 收稿日期:  2022-04-12
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