| APRI评分对HBV相关肝细胞癌切除术患者预后的预测价值 |
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| 引用本文： | 周运香,蒋燕霁,龚文锋,莫秋燕,刘颖春,周子寒,隆美英,陈佩琴,林秋伶,温秋萍,周先果,余红平,' target='_blank'>.APRI评分对HBV相关肝细胞癌切除术患者预后的预测价值[J].现代肿瘤医学,2023,0(6):1079-1085. |
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| 作者姓名： | 周运香 蒋燕霁 龚文锋 莫秋燕 刘颖春 周子寒 隆美英 陈佩琴 林秋伶 温秋萍 周先果 余红平 ' target='_blank'> |
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| 作者单位： | 1.广西医科大学公共卫生学院，广西 南宁 530021；2.广西医科大学附属肿瘤医院，广西 南宁 530021 |
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| 基金项目： | 广西科技计划项目（编号:AB18050020，AA18221001）；广西自然科学基金（编号:2018GXNSFDA050012）；上海市吴孟超医学科学基金（编号:JJHXM-2019042）；广西医科大学青年科学基金（编号:GXMUYSF202121） |
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| 摘 要： | 目的:评估天冬氨酸转氨酶与血小板计数比值指数（APRI）对HBV相关肝细胞癌（HCC）切除术患者术后总生存率（OS）的预测价值。方法:采用回顾性队列研究方法，收集2012年1月至2016年12月期间在广西医科大学附属肿瘤医院行切除术治疗的1 031例HBV相关HCC患者的术前临床资料。通过Kaplan-Meier生存曲线确定APRI评分的cutoff值。采用Kaplan-Meier法绘制不同APRI组患者的生存曲线，并通过Log-rank检验评估两组人群的生存差异。运用逐步多因素Cox回归筛选患者OS独立影响因素。采用限制性立方条图（RCS)评价患者APRI与死亡风险的相关性。建立列线图模型评估APRI对OS的预测能力并内部验证。结果:RCS显示APRI与死亡风险呈非线性关联（非线性P＜0.001）。多因素Cox回归结果显示:APRI、BCLC分期、AFP、性别和肿瘤大小是OS独立影响因素，高APRI组死亡风险是低APRI组2.1倍。患者OS的列线图显示APRI对OS的预测能力仅次于BCLC分期。在建模组和验证组中预测OS列线图的C-index分别为0.71（95%CI:0.68~0.74）、0.69（95%CI:0.64~0.75）；1和5年OS校正曲线显示列线图具有良好的校准度；临床决策曲线（DCA）显示模型具有良好的临床应用价值。结论:APRI是HBV相关HCC切除术患者OS独立影响因素，基于APRI对患者预后进行分层，有利于进行个体化治疗和随访。
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| 关 键 词： | APRI评分 肝细胞癌 乙型肝炎病毒 总生存率 列线图 |
The prognostic value of APRI score in patients with HBV-associated hepatocellular carcinoma undergoing hepatectomy |
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| ZHOU Yunxiang,JIANG Yanji,GONG Wenfeng,MO Qiuyan,LIU Yingchun,ZHOU Zihan,LONG Meiying,CHEN Peiqin,LIN Qiuling,WEN Qiuping,ZHOU Xianguo<.The prognostic value of APRI score in patients with HBV-associated hepatocellular carcinoma undergoing hepatectomy[J].Journal of Modern Oncology,2023,0(6):1079-1085. |
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| Authors: | ZHOU Yunxiang JIANG Yanji GONG Wenfeng MO Qiuyan LIU Yingchun ZHOU Zihan LONG Meiying CHEN Peiqin LIN Qiuling WEN Qiuping ZHOU Xianguo< |
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| Affiliation: | 1.School of Public Health,Guangxi Medical University,Guangxi Nanning 530021,China;2.Guangxi Medical University Cancer Hospital,Guangxi Nanning 530021,China. |
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| Abstract: | Objective:To evaluate the predictive value of the aspartate aminotransferase to platelet ratio index(APRI) for postoperative overall survival (OS) in patients undergoing resection for HBV-associated hepatocellular carcinoma (HCC).Methods:Used retrospective cohort study,we collected the preoperative clinical data of 1 031 patients with HBV-related HCC who underwent radical surgery in Guangxi Medical University Cancer Hospital from January 2012 to December 2016.The optimal cutoff value of APRI was obtained by Kaplan-Meier survival curve.Kaplan-Meier method was used to draw survival curves,and Log-rank test was used to compare the survival of groups with different levels of APRI.The independent influencing factors of OS were screened by stepwise multivariate Cox regression.The correlation between APRI and the risk of mortality was evaluated by restricted cubic spline(RCS).The ability of APRI to predict OS was evaluated by establishing nomogram and verify it internally.Results:RCS showed a non-linear correlation between APRI and the risk of mortality(non-linear P＜0.001).Multivariate Cox regression showed that APRI,BCLC stage,AFP,gender and tumor size were independent influencing factors of OS,and the risk of death in the group with high APRI was 2.1 times higher than that in the group with low APRI.The nomogram of patients' OS showed that APRI was second only to BCLC staging in predicting OS.The C-index of the OS nomogram was 0.71 (95%CI:0.68~0.74) in the train group and 0.69 (95%CI:0.64~0.75) in the test group.The 1 and 5-year OS correction curves showed that the nomogram model had good calibration.DCA curve showed that the model had good clinical application value.Conclusion:APRI is an independent factor affecting the OS of patients undergoing HBV-related HCC resection.Patients are stratified according to APRI for individualized treatment and follow-up. |
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| Keywords: | aspartate aminotransferase to platelet ratio index(APRI) hepatocellular carcinoma(HCC) hepatitis B virus(HBV) overall survival(OS) nomogram |
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