原发性肝癌患者TACE预后不良的因素分析：基于PSM法

doi:10.3760/cma.j.issn.1007-1245.2024.05.009

摘要/Abstract

摘要：

目的　基于倾向性评分匹配法（propensity score matching，PSM）探讨原发性肝癌（hepatocellular carcinoma，HCC）患者肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）预后不良的影响因素。方法　回顾性分析2017年1月至2020年1月郑州大学第一附属医院收治的496例HCC患者的临床资料，其中男305，女191例，年龄（58.19±7.24）岁，体质量指数（body mass index，BMI）（24.67±2.37）kg/m²。根据随访3年患者的生存情况，将其分为预后良好组（82例）和预后不良组（414例）。利用PSM对两组患者进行1∶1匹配，比较匹配后患者一般资料［肿瘤淋巴结转移（tumor node metastasis，TNM）分期、肝功能分级（Child-Pugh）分级、肿瘤长径、门静脉癌栓、肝硬化、远处转移、动静脉瘘、TACE治疗次数、碘油沉积分型、中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、血小板与淋巴细胞比值（platelet to lymphocyte ratio，PLR）、丙氨酸氨基转移酶（alanine transaminase，ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、γ-谷氨酰转肽酶（gamma-glutamyltransferase，GGT）、甲胎蛋白（alpha fetoprotein，AFP）］。计量资料采用独立样本t检验，计数资料采用χ²检验，并将差异有统计学意义的指标纳入多因素COX回归分析，筛查HCC患者TACE预后不良的影响因素。结果　匹配前，预后良好组和预后不良组患者性别、BMI、吸烟史、糖尿病史、高血压史、肿瘤分布情况比较，差异均无统计学意义（均P>0.05）；两组年龄、饮酒史比较，差异均有统计学意义（均P<0.05）。经PSM匹配后，预后良好组和预后不良组均得到78例HCC患者，两组患者性别、年龄、BMI、吸烟史、饮酒史、糖尿病史、高血压史、肿瘤分布情况比较，差异均无统计学意义（均P>0.05）。匹配后，预后不良组和预后良好组肝硬化、TACE治疗次数、NLR、PLR、ALT和AST水平比较，差异均无统计学意义（均P>0.05）；预后不良组和预后良好组TNM分期为Ⅲa期［58.97%（46/78）比26.92%（21/78）］、Child-Pugh分级为B级［62.82%（49/78）比29.49%（23/78）］、肿瘤长径>5 cm［47.44%（37/78）比29.49%（23/78）］、多发肿瘤［48.72%（38/78）比32.05%（25/78）］、门静脉癌栓［41.03%（32/78）比17.95%（14/78）］、远处转移［21.79%（17/78）比8.97%（7/78）］、动静脉瘘［21.79%（17/78）比5.13%（4/78）］、碘油沉积为Ⅲ+Ⅳ分型［38.46%（30/78）比14.10%（11/78）］、GGT>50 U/L［88.46%（69/78）比73.08%（57/78）］、AFP>400 μg/L［55.13%（43/78）比28.21%（22/78）］比较，差异均有统计学意义（χ²=16.351、17.437、5.308、4.500、9.989、4.924、9.299、11.944、5.943、11.631，均P<0.05）。COX回归分析结果显示，TNM分期为Ⅲa期（HR=3.504，95%CI 1.548～7.935）、Child-Pugh分级为B级（HR=4.345，95%CI 1.889～9.994）、肿瘤长径>5 cm（HR=2.084，95%CI 1.115～3.893）、门静脉癌栓（HR=2.547，95%CI 1.217～5.333）、远处转移（HR=1.900，95%CI 1.078～3.348）、动静脉瘘（HR=2.291，95%CI 1.163～4.514）、碘油沉积为Ⅲ+Ⅳ分型（HR=3.089，95%CI 1.359～7.023）、GGT>50 U/L（HR=2.206，95%CI 1.137～4.278）、AFP>400 μg/L（HR=2.821，95%CI 1.283～6.202）均是影响HCC患者TACE预后不良的危险因素（均P<0.05）。结论　经PSM均衡协变量后，TNM分期为Ⅲa期、Child-Pugh分级为B级、肿瘤长径>5 cm、门静脉癌栓、远处转移、动静脉瘘、碘油沉积为Ⅲ+Ⅳ分型、GGT>50 U/L、AFP>400 μg/L均是HCC患者TACE预后不良的影响因素。

关键词:

原发性肝癌, 肝动脉化疗栓塞术, 预后不良, 倾向性评分匹配法

Abstract:

Objective　To investigate the influencing factors of poor prognosis after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) based on propensity score matching (PSM). Methods　The clinical data of 496 patients with HCC admitted to First Hospital, Zhengzhou University from January 2017 to January 2020 were retrospectively analyzed; there were 305 males and 191 females; they were (58.19±7.24) years old; their body mass index (BMI) was (24.67±2.37) kg/m². According to the patients' survival after 3 years' follow up, they were divided into a good prognosis group (82 cases) and a poor prognosis group (414 cases). PSM was used to perform 1 : 1 matching between the two groups. The patients' general data [tumor node metastasis (TNM) stage, Child-Pugh classification, maximum tumor diameter, portal vein tumor thrombus, cirrhosis, distant metastasis, arteriovenous fistula, TACE treatment times, lipiodol deposition classification, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and alpha fetoprotein (AFP)] after matching were compared. The independent sample t test was used to compare the measurement data, and the χ² test was used to compare the count data. The indicators with statistical differences were included into the multivariate COX regression analysis to screen the influencing factors of the poor prognosis after TACE in the HCC patients. Results　Before matching, there were no statistical differences in gender, BMI, smoking history, diabetes history, hypertension history, and tumor distribution between the good prognosis group and the poor prognosis group (all P>0.05), while there were statistical differences in age and drinking history (both P<0.05). After PSM matching, 78 cases of HCC patients were obtained from both the good prognosis group and the poor prognosis group, and there were no statistical differences in gender, age, BMI, smoking history, drinking history, diabetes history, hypertension history, and tumor distribution between the two groups (all P>0.05). After matching, there were no statistical differences in liver cirrhosis, TACE treatment times, NLR, PLR, ALT, and AST between the poor prognosis group and the good prognosis group (all P>0.05), but there were statistical differences in the TNM stage Ⅲa [58.97% (46/78) vs. 26.92% (21/78)], Child-Pugh B [62.82% (49/78) vs. 29.49% (23/78)], maximum tumor diameter > 5 cm [47.44% (37/78) vs. 29.49 % (23/78)], multiple tumors [48.72% (38/78) vs. 32.05% (25/78)], portal vein tumor thrombus [41.03% (32/78 ) vs. 17.95%(14/78)], distant metastasis [21.79% (17/78) vs. 8.97% (7/78)], arteriovenous fistula [21.79% (17/78) vs. 5.13% (4/78)], lipiodol deposition type Ⅲ + Ⅳ [38.46% (30/78) vs. 14.10% (11/78)], GGT > 50 U/L [88.46% (69/78) vs. 73.08% (57/78)], and AFP > 400 μg/L [55.13% (43/78) vs. 28.21% (22/78)] between the poor prognosis group and the good prognosis group (χ²=16.351, 17.437, 5.308, 4.500, 9.989, 4.924, 9.299, 11.944, 5.943, and 11.631; all P < 0.05). The COX regression analysis showed that TNM stage Ⅲa (HR=3.504, 95%CI 1.548-7.935), Child-Pugh grade B (HR=4.345, 95%CI 1.889-9.994), maximum tumor diameter > 5 cm (HR=2.084, 95%CI 1.115-3.893), portal vein tumor thrombus (HR=2.547, 95%CI 1.217-5.333), distant metastasis (HR=1.900, 95%CI 1.078-3.348), arteriovenous fistula (HR=2.291, 95%CI 1.163-4.514), lipiodol deposition Ⅲ+Ⅳ type (HR=3.089, 95%CI 1.359-7.023), GGT > 50 U/L (HR=2.206, 95%CI 1.137-4.278), and AFP > 400 μg/L (HR=2.821, 95%CI 1.283-6.202) all were risk factors for the poor prognosis of the HCC patients after TACE (all P<0.05). Conclusion　After PSM balanced covariates, TNM stage Ⅲa, Child-Pugh grade B, maximum tumor diameter > 5 cm, portal vein tumor thrombus, distant metastasis, arteriovenous fistula, lipiodol deposition Ⅲ+Ⅳ type, GGT > 50 U/L, and AFP > 400 μg/L all are factors affecting the poor prognosis after TACE in HCC patients.

Key words:

Hepatocellular carcinoma, Hepatic arterial chemoembolization, Poor prognosis, Propensity score matching

张国坤张天佑张景畅李素新.

原发性肝癌患者TACE预后不良的因素分析：基于PSM法 [J]. 国际医药卫生导报, 2024, 30(5): 747-753.

Zhang Guokun, Zhang Tianyou, Zhang Jingchang, Li Suxin.

Analysis of factors affecting poor prognosis after TACE in patients with hepatocellular carcinoma based on PSM [J]. International Medicine and Health Guidance News, 2024, 30(5): 747-753.

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