| 吴伟珍,戚茂建,唐海军,等.肝细胞癌合并门静脉癌栓危险因素分析及诊断模型构建[J].肿瘤学杂志,2025,31(6):481-487. |
| 肝细胞癌合并门静脉癌栓危险因素分析及诊断模型构建 |
| Risk Factors for Portal Vein Tumor Thrombus in Patients with Hepatocellular Carcinoma and Construction of a Diagnostic Model |
| 投稿时间：2024-09-16 |
| DOI：10.11735/j.issn.1671-170X.2025.06.B003 |
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| 中文关键词: 肝细胞癌 门静脉癌栓 远处转移 异常凝血酶原 D-二聚体 诊断 |
| 英文关键词:hepatocellular carcinoma portal vein tumor thrombus distant metastasis Des-gamma carboxy prothrombin D-dimer diagnosis |
| 基金项目:广西自然科学基金项目（2018GXNSFAA281126） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨影响肝细胞癌合并门静脉癌栓的危险因素并构建诊断模型。［方法］ 回顾性收集2021年7月至2023年11月广西医科大学第一附属医院收治的84例肝细胞癌患者的临床资料，根据腹部CT、MRI或术后病理结果是否有门静脉癌栓形成分为癌栓组（44例）和非癌栓组（40例）。比较两组临床资料，Logistic逐步回归法分析肝细胞癌合并门静脉癌栓的影响因素，构建列线图（Nomogram）模型，绘制校准曲线评估模型校准度，绘制受试者工作特征（receiver operating characteristic，ROC）曲线评估模型诊断效能，绘制决策曲线、临床影响曲线评估模型临床实用性。［结果］ Logistic回归分析显示，肿瘤有远处转移（OR=4.885，95%CI：1.632~14.620，P=0.005）、维生素K缺乏或拮抗剂-Ⅱ诱导的蛋白质（protein induced by vitamin K absence or antagonist-Ⅱ，PIVKA-Ⅱ，又称异常凝血酶原）（OR=2.805，95%CI：1.052~7.476，P=0.039）水平升高、D-二聚体（D-dimer，D-D）水平升高（OR=3.059，95%CI：1.313~7.127，P=0.010）与肝细胞癌合并门静脉癌栓形成相关。构建Nomogram模型，经验证校准曲线接近理想曲线，ROC曲线下面积为0.818（95%CI：0.730~0.906，P<0.001），决策曲线和临床影响曲线显示该模型具有较好的临床实用性。［结论］ 肿瘤远处转移及血清PIVKA-Ⅱ、血浆D-D水平与门静脉癌栓的发生相关，基于三者构建的诊断模型对肝细胞癌合并门静脉癌栓的早期诊断具有一定的临床意义和参考价值。 |
| 英文摘要: |
| Abstract： ［Objective］ To identify risk factors for portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC) and to develop a diagnostic model. ［Methods］ Clinical datas from 84 HCC patients treatment in The First Affiliated Hospital of Guangxi Medical University between July 2021 and November 2023 were analyzed retrospectively. Based on the presence of PVTT confirmed by abdominal CT， MRI， or postoperative pathological evaluation， the patients were categorized into a thrombus group (n=44) and a non-thrombus group (n=40). The clinical data were compared between the two groups. Stepwise logistic regression was utilized to identify the influencing factors associated with PVTT. A Nomogram model was subsequently developed， and a calibration curve was constructed to evaluate the calibration accuracy of the model. The diagnostic performance of the model was assessed using the receiver operating characteristic (ROC) curve. Decision curve analysis and clinical impact curves were used to evaluate the clinical applicability and utility of the model. ［Results］ Logistic regression analysis identified that distant metastasis (OR=4.885， 95%CI： 1.632~14.620， P=0.005)， elevated PIVKA-Ⅱ levels (OR=2.805， 95%CI： 1.052~7.476，P=0.039)， and elevated D-dimer (D-D) levels (OR=3.059， 95%CI： 1.313~7.127， P=0.010) were independent risk factors associated with PVTT in HCC patients. A nomogram model was developed， and the calibration curve demonstrated good agreement with the ideal reference line. The area under the ROC curve (AUC) of the Nomogram for diagnosis was 0.818 (95%CI： 0.730~0.906， P<0.001). Decision curve analysis and the clinical impact curve further confirmed the favorable clinical utility of the model. ［Conclusion］ Distant metastasis， serum PIVKA-Ⅱ and plasma D-D levels are significantly associated with the development of PVTT in HCC patients. The diagnostic model constructed based on these three factors demonstrates promising clinical utility and may serve as a tool for the early diagnosis of PVTT in hepatocellular carcinoma patients. |
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