摘要目的 分析肝细胞癌初治患者消融术后早期(＜2年)复发的独立危险因素,构建复发预测模型.方法 回顾性分析北京佑安医院2016年1至12月行消融术的81例乙肝相关性肝细胞癌初治患者,男66例、女15例,收集人口学资料、肝功能指标、肿瘤相关指标以及消融方式等信息.单因素和多因素Logistic回归分析确定独立危险因素,受试者工作特征曲线确定其预测效能.Cox比例风险回归建立预测模型,根据风险比对危险因素进行赋分,根据得分高低分为高危组和低危组.Kaplan-Meier法计算无复发生存率.结果 肿瘤个数、纤维蛋白原(Fib)、血小板-淋巴细胞比值(PLR)是肝细胞癌早期复发的独立危险因素.纤维蛋白原、PLR和Fib-PLR预测患者预后的曲线下面积分别为72.9％、71.5％和81.8％.低危组6个月、1年和2年的累积复发率分别为4.9％、7.3％和29.3％;高危组为14.6％、43.9％和78.1％,两组差异均有统计学意义(均P＜0.05).结论 肿瘤个数、纤维蛋白原和PLR三者联合可作为肝细胞癌患者消融术后早期复发的预警指标.

abstractsObjective To explore the risk factors in HBV-associated hepatocellular carcinoma (HCC) patients with early recurrence after ablation and to establish predictive model.Methods A total of 81 patients with HBV-related HCC who underwent ablation from January 2016 to December 2016 were included in Beijing Youan Hospital,including 66 males and 15 females.Standard medical records were collected,which were summarized as follows:demographic data,liver function,the number and size of tumors and the modality of ablation.Univariate and multivariate analysis were performed to identify the independent risk factors.The ROC curve was used to determine prognostic value.Cox proportional hazards model was used to establish predictive model,and the scores of risk factors were assigned according to HR value.Patients were divided into high-risk group and low-risk group in accordance with scores.The analysis of early recurrence rate was performed by the Kaplan-Meier method.Results Tumor number,fibrinogen (Fib) and platelet-lymphocyte rate (PLR) were independently correlated with recurrence-free survival (RFS).The AUCs of Fib,PLR and Fib-PLR were 72.9％,71.5％ and 81.8％.The recurrence rates of the low-risk group were 4.9％,7.3％ and 29.3％ at 6 months,12 months and 24 months while 14.6％,43.9％ and 78.1％ in high-risk group.Two groups revealed statistically significant differences (all P＜0.05).Conclusion Tumor number,Fib,and PLR may be used as a set of predictive indicator of early recurrence in HBV-associated HCC patients after ablation.