| 李春梅,郑相如,杨子懿,等.BCLC A/B期肝细胞癌患者经动脉化疗栓塞联合局部射频消融治疗后复发的影响因素及列线图构建[J].肿瘤学杂志,2026,32(2):141-149. |
| BCLC A/B期肝细胞癌患者经动脉化疗栓塞联合局部射频消融治疗后复发的影响因素及列线图构建 |
| Risk Factors for Recurrence in Patients with BCLC Stage A/B Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization Combined with Local Radiofrequency Ablation Treatment and Construction of a Nomogram Model for Prediction of Recurrence-Free Survival |
| 投稿时间：2025-02-12 |
| DOI：10.11735/j.issn.1671-170X.2026.02.B008 |
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| 中文关键词: 肝细胞癌 巴塞罗那临床肝癌分期 射频消融 经动脉化疗栓塞 复发 列线图 |
| 英文关键词:hepatocellular carcinoma Barcelona Clinic Liver Cancer stage radiofrequency ablation transcatheter arterial chemoembolization recurrence Nomogram |
| 基金项目:重庆市医学科研创新基金项目（Y2023HLKYZDXM03）；重庆市渝北区科卫联合医学科研项目（2023YBKW19） |
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| 中文摘要: |
| 摘 要：［目的］分析与巴塞罗那临床肝癌（Barcelona Clinic Liver Cancer，BCLC）分期 A/B期肝细胞癌（hepatocellular carcinoma，HCC）患者经动脉化疗栓塞（transcatheter arterial chemoembolization，TACE）联合局部射频消融（radiofrequency ablation，RFA）治疗后复发相关因素，并建立列线图模型。［方法］ 回顾性分析2019年10月至2024年5月在重庆医科大学附属第三医院接受TACE联合局部RFA治疗、Child-Pugh分级A级或B级、BCLC分期为A期或B期的180例HCC患者的临床资料。根据7∶3的比例将患者随机分为训练集（n=126）和验证集（n=54）。记录患者的人口统计学、病史、血常规、肝功能、凝血检查、肿瘤特征以及无复发生存期（recurrence-free survival，RFS）。采用LASSO及Cox回归分析复发的影响因素，并建立列线图。［结果］ 经LASSO及Cox回归分析，确定γ -谷氨酰转肽酶与淋巴细胞比值（γ-glutamyl transpeptidase-lymphocyte ratio，GLR）、白蛋白/球蛋白（albumin to globulin ratio，AGR）、肿瘤数目、肿瘤大小均为HCC患者RFS的独立影响因素。通过GLR、AGR、肿瘤数目、肿瘤大小建立列线图模型，训练集和验证集列线图模型的C指数值分别为0.759（95%CI：0.697～0.822）、0.715（95%CI：0.663～0.794），能够较好地区分复发和非复发HCC患者，两个队列的1、3、5年RFS受试者工作特征曲线下面积均＞0.750。校准曲线也提示列线图在训练集及验证集实际生存概率和预测概率之间具有良好的预测准确性。决策曲线分析显示，该列线图模型在训练集及验证集中具有较高的临床效用。［结论］ 通过GLR、AGR、肿瘤数目、肿瘤大小建立的列线图模型显示了对HCC患者的良好区分、校准和临床效用，可提供1、3、5年RFS的个性化预测，及时识别高危HCC人群，有助于临床制定长期治疗和随访方案。 |
| 英文摘要: |
| Abstract：［Objective］ To analyze the risk factors associated with recurrence in patients with Barcelona Clinic Liver Cancer (BCLC) stage A/B hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE) combined with local radiofrequency ablation (RFA)， and to establish a prediction Nomogram model for recurrence-free survival (RFS) of patients. ［Methods］ The clinical data of 180 HCC patients with Child-Pugh grade A or B， and BCLC stage A or B who received TACE combined with local RFA treatment in The Third Affiliated Hospital of Chongqing Medical University from October 2019 to May 2024， were retrospectively analyzed. Patients were randomly divided into a training set (n=126) and a validation set (n=54) at a ratio of 7∶3. The demographics， medical history， blood routine， liver function， coagulation indicators， tumor characteristics， and 1-year， 3-year， 5-year RFS were recorded； the risk factors associated with recurrence were analyzed by LASSO and Cox regression and a prediction Nomogram model for RFS was developed. ［Results］ LASSO and Cox regression analysis showed that γ-glutamyl transpeptidase-lymphocyte ratio (GLR)， albumin to globulin ratio (AGR)， tumor number and tumor size were identified as independent risk factors for RFS in HCC patients. The established Nomogram model included variables of GLR， AGR， tumor number and tumor size. The C-index values of Nomogram models for the training set and validation set were 0.759 (95%CI： 0.697～0.822) and 0.715 (95%CI： 0.663～0.794)， respectively， and the area under the receiver characteristic curves (AUC) for predicting 1-， 3 - and 5-year RFS of both cohorts were＞0.750. The calibration curve also indicates that the Nomogram had good prediction accuracy between the actual survival and the prediction probability of the training set and the validation set. Decision curve analysis showed that the Nomogram model had high clinical effectiveness in training and validation sets. ［Conclusion］ The Nomogram model established with GLR， AGR， tumor number and tumor size shows good differentiation， calibration and clinical effectiveness for prediction of 1-year， 3-year and 5-year RFS in HCC patients. |
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