[1]李大伟,周振堰,周长友,等.ALT/AST及影像学特征预测肝癌经动脉化疗栓塞患者的预后 [J].介入放射学杂志,2024,33(08):849-854.
　LI Dawei,ZHOU Zhenyan,ZHOU Changyou,et al. Application of serum AST/ALT ratio and imaging features in predicting the prognosis of patients with hepatocellular carcinoma after receiving transarterial chemoembolization[J].journal interventional radiology,2024,33(08):849-854.
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ALT/AST及影像学特征预测肝癌经动脉化疗栓塞患者的预后
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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
33
期数:
2024年08
页码:
849-854
栏目:
肿瘤介入
出版日期:
2024-08-12

文章信息/Info

Title:
 Application of serum AST/ALT ratio and imaging features in predicting the prognosis of patients with hepatocellular carcinoma after receiving transarterial chemoembolization
作者:
李大伟; 周振堰; 周长友; 张宁平; 尚海龙; 王一超
Author(s):
LI Dawei; ZHOU Zhenyan; ZHOU Changyou; ZHANG Ningping; SHANG Hailong; WANG Yichao.
Department of Radiology，Guangci Branch of the First Affiliated Hospital of Soochow University（Suzhou Guangci Cancer Hospital），Suzhou，Jiangsu Province 215128，China
关键词:
【关键词】肝癌;  经动脉化疗栓塞;  丙氨酸氨基转移酶/天冬氨酸氨基转移酶比值;  预后;  诺模图
文献标志码:
A
摘要:
【摘要】目的探讨经动脉化疗栓塞（transarterial chemoembolization，TACE）治疗前血清丙氨酸转氨酶/天冬氨酸转氨酶比值（ALT/AST）及影像学特征与肝癌患者预后的关系，构建预测患者总体生存率（overall survival，OS）的诺模图模型。方法纳入2016年7月至2020年7月苏州大学附属第一医院广慈分院诊断为肝癌并以TACE作为初始治疗的患者211例，将其随机分为建模组139例，验证组72例。采用受试者工作特征（receiver operation characteristics，ROC）曲线确定AST/ALT的最佳临界值。在建模组患者中进行单、多因素Cox回归分析，筛选影响肝癌患者OS的独立预测因素并构建预后模型。通过Harrell一致性指数（C指数）评价诺模图对肝癌患者OS的预测能力，校准曲线用于评估预后模型的预测准确性。结果建模组与验证组患者的基线特征分布差异均无统计学意义（均P>0.05）。两组患者中位OS分别为28.5个月（95%CI：22.1~34.9）和25.1个月（95%CI：19.2~29.0），差异无统计学意义（χ２= 1.395，P=0.322）。AST/ALT预测肝癌患者OS的最佳临界值为1.10，曲线下面积（area under curve，AUC）为0.674（95%CI：0.604~0.753）。Cox回归分析表明，肿瘤个数（HR=2.080，95%CI：1.245~3.475，P=0.005）、肿瘤包膜（HR=1.771，95%CI：1.128~2.780，P=0.013）、不规则边缘强化（HR=1.884，95%CI：1.190~2.984，P=0.007）和AST/ALT（HR=2.450，95%CI：1.506~3.987，P<0.01）是接受TACE治疗肝癌患者的独立预后因素。基于以上变量构建预测OS的诺模图模型，其在建模组与验证组中的C指数分别为0.733（95%CI：0.650~0.826）和0.770（95%CI：0.688~0.862）。校准曲线显示预后模型对1、2和3年OS的预测曲线与理想参考线之间未见明显偏离。结论基于肿瘤个数、影像学特征及AST/ALT的诺模图对接受TACE治疗的肝癌患者预后显示了良好的预测价值。

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备注/Memo

备注/Memo:
（收稿日期：2023-07-17）
（本文编辑：新宇）
更新日期/Last Update: 2024-08-08