关键词: 原发性肝细胞肝癌, 微血管侵犯, Logistic回归分析

Abstract:

Objective To establish a judgment model of microvascular invasion（MVI） in hepatocellular carcinoma（HCC） based on common clinical determination items. Methods A total of 5 602 patients with HCC were enrolled as training group,and 1 905 patients with HCC were enrolled as validation group. The clinical data,including sex,age,tumor number,tumor size,Edmondson grade,MVI occurrence and preoperative 48 indexes,were collected. In training group, Logistic regression analysis was used to evaluate the risk factors of MVI in patients with HCC before operation,a judgment model was established,and independent validation was performed in validation group. Receiver operating characteristic（ROC） curve was used to evaluate the performance of the judgment model,PA-SALAD,for the diagnosis of MVI occurrence in preoperative HCC patients. Results There was statistical significance in age,albumin（Alb）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,alkaline phosphatase（ALP）,alpha-L-fucosidase（AFU）,sialic acid（SA）,prothrombin time（PT）,tumor number,tumor size and MVI ratio between training and validation groups（P<0.05）. There was no statistical significance for the other indexes between the 2 groups（P>0.05）. Logistic regression analysis showed that age,platelet（PLT）,Alb,SA,alpha-fetoprotein（AFP）,des-gamma-carboxy prothrombin（DCP） and alpha-fetoprotein heterogeneity（AFP-L3） were risk factors for MVI occurrence [odds ratios（OR） were 0.981,0.998,0.971,1.016,1.226,1.361 and 1.012]. Based on the results of Logistic regression analysis,the judgment model,PA-SALAD=0.220-0.002×PLT-0.019×age+0.016×SA-0.029×Alb+0.012×AFP-L3+0.204×lgAFP+0.308×lgDCP,was established. ROC curve analysis showed that the area under curve（AUC）,sensitivity and specificity of PA-SALAD for discriminating MVI in training group were 0.695,69.3% and 60.4%,and the optimal cut-off value was -0.235 3. In validation group,the AUC,sensitivity and specificity were 0.704,66.5% and 62.0%,and the optimal cut-off value was -0.235 3. Conclusions The judgment model,PA-SALAD,based on common clinical determination items is of certain value to determine whether MVI occurs in HCC patients,especially for patients at high risk of MVI.

Key words: Hepatocellular carcinoma, Microvascular invasion, Logistic regression model