摘要目的 探讨GALAD模型[包括性别(gender)、年龄(age)、甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、异常凝血酶原(DCP)]对原发性肝细胞癌诊断以及预测微血管侵犯(MVI)的价值.方法 采用回顾性研究方法,选择2015年1月至2018年12月在东方肝胆外科医院接受根治性手术治疗的原发性肝细胞癌(HCC)患者5919例为研究组,选取同期良性肝脏疾病(BLDs)1745例为对照组,采用LUMIPULSE G1200全自动免疫分析仪检测DCP浓度,罗氏Cobas e601全自动免疫分析仪检测血清AFP浓度,通过亲和吸附离心法检测AFP-L3,两组间比较采用非参数Mann-Whitney检验,率的比较采用卡方检验,分析单个血清学标志物与GALAD模型对原发性肝细胞癌的诊断价值,同时评价GALAD模型对原发性肝细胞癌发生MVI的预测效能.结果 与单个血清标志物相比,GALAD模型对原发性肝细胞癌的诊断价值更高,在截断值为-0.33时,诊断敏感度、特异度和准确性分别为91.9％(5440/5919)、86.8％(1515/1745)和90.7％(6955/7664),曲线下面积可达0.960[95％CI(0.955～0.964)].与未发现MVI(MO)相比,MVI低危组(M1)、MVI高危组(M2)、发现MVI(M1+2)的GALAD模型值均显著升高(Z值分别为-12.517、-22.883、-21.655,P<0.05),GALAD模型预测高危组MVI(M2)曲线下面积为0.717[95％CI(0.701～0.733)](M0比M2).结论 GALAD模型用于原发性肝细胞癌的诊断性能更优,并对MVI具有一定的预测价值.

abstractsObjective To explore the value of GALAD model, including gender, age, AFP, AFP-L3 and DCP in diagnosis of primary hepatocellular carcinoma and prediction of microvascular invasion (MVI). Methods Using retrospective study method, 5919 patients with primary hepatocellular carcinoma (HCC) who received radical operation from January 2015 to December 2018 in Eastern Hepatobiliary Surgery Hospital were enrolled into study group. At the same time, 1745 patients with benign liver diseases (BLDs) were enrolled into control group. The concentration of DCP was detected by Lumipulse G1200 automatic immune analyzer, and the concentration of AFP was detected by Cobas e601 automatic immune analyzer. AFP-L3 was detected by affinity adsorption centrifugation. The non-parametric Mann Whitney test was used to compare the difference between two groups. The chi square test was used to compare the rates. The diagnostic value of single serological marker and GALAD model for primary hepatocellular carcinoma was analyzed. The predictive effect of GALAD model on MVI of primary hepatocellular carcinoma was evaluated. Results Compared with single serum marker, the diagnostic value of GALAD model is higher. When the cutoff value is-0.33, the diagnostic sensitivity, specificity and accuracy reach to 91.9％(5440/5919), 86.8％ (1515/1745) and 90.7％ (6955/7664), respectively. The area under the curve can reach 0.960 [95％CI (0.955-0.964)]. Compared with no MVI (MO) group, the value of GALAD model in MVI low-risk group (M1), MVI high-risk group (M2) and MVI (M1+2) were significantly higher (Z values were-12.517,-22.883,-21.655, P<0.05), Galad model predicts MVI (M2) in high risk group, AUC was 0.717 [95％CI (0.701-0.733)] (M0 ratio M2). Conclusion GALAD model has better diagnostic performance in primary hepatocellular carcinoma and has certain predictive value for microvascular invasion.