目的

探讨肝细胞癌（肝癌）患者TACE术后1年内复发的危险因素，并构建列线图预测模型。

方法

回顾性分析2021年8月至2022年8月在中山大学附属第三医院首次行TACE的85例肝癌初诊患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男78例，女7例；平均年龄（58±12）岁。肝癌CNLC分期Ⅰb期22例，Ⅱa期12例，Ⅱb期24例，Ⅲa期9例，Ⅲb期18例；肿瘤直径1.5～19.2 cm，中位直径6.0 cm；多发49例，单发36例。按TACE术后短期复发状态分为短期预后良好组和短期预后不良组，收集两组一般临床资料及检验指标等相关资料，Cox回归分析短期预后影响因素，采用R语言构建列线图模型。绘制校准曲线，同时进行模型内部验证。采用ROC曲线下面积（AUC）评估该模型的预测价值，使用决策曲线分析（DCA）评估该模型的临床价值。

结果

Cox单因素回归分析显示，AFP（HR=5.055，95%CI：2.224～11.490）、肝硬化（HR=6.261，95%CI：1.862～21.060）、IL-6差值（HR=0.409，95%CI：0.171～0.979）和C-反应蛋白（CRP）差值（HR=2.905，95%CI：1.158～7.287）与TACE术后短期复发有关（P＜0.05）；Cox多因素回归分析显示，AFP≥400 μg/L（HR=3.722，95%CI：1.543～8.978）、肝硬化（HR=4.406，95%CI：1.249～15.548），IL-6差值≥18.79 pg/ml（HR=0.312，95%CI：0.119～0.819），CRP差值≥36.67 mg/L（HR=4.967，95%CI：1.895～13.021）是TACE术后短期复发的独立危险因素（P＜0.05）。基于独立危险因素绘制列线图模型，模型内部验证显示预测TACE术后复发的一致性指数（C-index）为0.875（95%CI:0.842～0.907），分辨度良好；ROC曲线分析该模型预测术后1年无复发生存的AUC为0.794，DCA评估该模型的临床价值，提示该模型的净获益值大，临床价值比较高。

结论

AFP、肝硬化、IL-6差值和CRP差值是TACE治疗的肝癌患者术后短期复发的独立危险因素，以此为指标成功构建了预测TACE术后复发的列线图模型，该模型在预判肝癌患者复发情况具有一定的实用价值。

Objective

To investigate the risk factors of recurrence in patients with hepatocellular carcinoma （HCC） within 1 year after TACE，and establish a nomogram prediction model.

Methods

Clinical data of 85 patients newly diagnosed with HCC who underwent transarterial chemoembolization（TACE） for the first time in the Third Affiliated Hospital of Sun Yat-sen University from August 2021 to August 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，78 patients were male and 7 female，aged （58±12） years on average. According to the China liver cancer （CNLC） staging system，22 patients were classified as CNLC stage Ⅰb，12 cases of stage Ⅱa，24 cases of stage Ⅱb，9 cases of stage Ⅲa and 18 cases of stage Ⅲb，respectively. The tumor diameter was ranged from 1.5 to 19.2 cm，with a median diameter of 6.0 cm. 49 cases had multiple tumors and 36 cases with single tumor. According to patients' situation of short-term recurrence after TACE，all patients were divided into the favorable and poor prognosis groups. Clinical data and detection parameters in two groups were collected. Cox's regression model was used to analyze the influencing factors of short-term prognosis，and R language was adopted to establish the nomograph model.The calibration curve was delineated and internal validation of the prediction model was performed. The area under the receiver operating characteristic （ROC） curve （AUC） was employed to evaluate the predictive value of this model. Decision curve analysis （DCA） was adopted to evaluate the clinical value of this model.

Results

Univariate Cox's regression analysis showed that AFP （HR=5.055，95%CI: 2.224-11.490），liver cirrhosis （HR=6.261，95%CI: 1.862-21.060） and differences of IL-6 levels （HR=0.409，95%CI: 0.171-0.979）and differences of C-reactive protein （CRP） levels （HR=2.905，95%CI: 1.158-7.287） were correlated with short-term recurrence after TACE （P＜0.05）. Multiple Cox's regression analysis showed that AFP≥400 μg/L（HR=3.722，95%CI: 1.543-8.978），liver cirrhosis （HR=4.406，95%CI: 1.249-15.548） and the differences of IL-6 levels≥18.79 pg/ml （HR=0.312，95%CI: 0.119-0.819） and the differences of CRP levels≥36.67 mg/L（HR=4.967，95%CI: 1.895-13.021） were the independent risk factors of short-term recurrence after TACE（P＜0.05）. A nomogram model was drawn based on these independent risk factors. Internal validation of this model showed that the concordance index （C-index） for predicting the recurrence of HCC after TACE was 0.875 （95%CI: 0.842-0.907），and the degree of discrimination was high. ROC curve analysis revealed that the AUC of this model for predicting 1-year recurrence-free survival was 0.794. DCA demonstrated that this model had large net benefit value and relatively high clinical value.

Conclusions

AFP，liver cirrhosis，the differences of IL-6 and CRP levels are the independent risk factors for postoperative short-term recurrence in HCC patients after TACE. Based on these parameters，a nomogram model for predicting postoperative recurrence of HCC is successfully established，which has certain practical value in predicting the recurrence of HCC.