作者：张文坚1，崔理锋1，杨继林1，鲍世韵1,2，刘利平1,2

单位：1.暨南大学第二临床医学院， 广东 深圳 518020；2.深圳市人民医院 肝胆胰外科， 广东 深圳 518020

Authors: Zhang Wenjian1，Cui Lifeng1，Yang Jilin1，Bao Shiyun1,2，Liu Liping1,2

Unit: 1.Second Clinical College of Jinan University，Shenzhen 518020，Guangdong，China；2.Department of Hepatobiliary Pancreatic Surgery，Shenzhen People’s Hospital，Shenzhen 518020，Guangdong，China

摘要：

目的 研究原发性肝细胞癌切除术后复发的危险因素，构建列线图复发预测模型并评价其预测效果。方法 回顾性分析2015年7月至2021年9月在深圳市人民医院接受肝癌切除术的肝细胞癌患者的临床资料，构建预测患者无瘤生存(DFS)率的列线图模型。结果 共纳入262例患者，82.06%患者为男性；71.76%患者乙型肝炎表面抗原(HBsAg)阳性，59.16%既往有肝硬化，35.11%既往行抗病毒治疗。93.51%为单发肿瘤，39.7%患者肿瘤直径≥50 mm;5.3%影像学提示有门静脉癌栓PVT;11.1%肿瘤为低分化；30.53%有微血管浸润(MVI)。Cox比例风险模型进行单因素和多因素分析表明：肿瘤直径≥50 mm、γ-谷氨酰基转移酶(GTP)≥36 U/L、MVI以及MPVI是影响肝切除术后肿瘤复发的独立危险因素。根据总评分的最佳截断值12.3，分为高危复发风险及低危复发风险患者，其中低危复发风险患者1年、3年及5年DFS率分别为77.8%、66.1%、60.7%，高危复发风险患者1年、3年及5年DFS率分别为37.9%、24.2%、24.2%，差异有统计学意义(χ2=43.742,P<0.001)。结论 通过肿瘤直径≥50 mm、GTP≥36 U/L、MVI以及PVTT等因素构建的列线图模型，可以较准确地评估肝癌患者行肝癌切除术后复发风险，评估为高危组的患者应尽早干预。

关键词：肝细胞癌； 肝癌切除术； 预测模型； 列线图

Abstract：

Objective The purpose of this study was to study the risk factors of recurrence after resection of primary liver cancer (PLC)，to construct a predictive nomogram model of recurrence and to evaluate the prognosis of patients. Method The clinical data of 262 patients with PLC who underwent hepatectomy in Shenzhen People's Hospital from July 2015 to September 2021 were analyzed retrospectively. A nomogram model was constructed to predict the disease-free survival of patients. Result  A total of 262 patients were included，82.06% of the patients were male，71.76% of the patients were HBsAg positive，59.16% had previous liver cirrhosis，35.11% of the patients were treated with antiviral therapy. 93.51% were solitary tumors，39.7% patients with tumor diameter 39.7% tumor diameter≥50 mm，5.3% of the patients reported （portal vein tumor thrombosis，PVTT）,11.1% of the tumors were poorly differentiated，and 30.53% had microvascular invasion (MVI). univariate and multivariate Cox proportional hazard model showed that tumor diameter≥50 mm，γ-glutamyl transferase (GTP)≥36 U/L，MVI and PVTT were independent risk factors for tumor recurrence after hepatectomy Based on the best cut-off value of 12.3 for the total score, patients were classified as high-risk of recurrence and low-risk of recurrence patients. The 1-year, 3-year and 5-year DFS in the low-risk of recurrence patients were 77.8%，66.1% and 60.7%，while those in the high-risk of recurrence patients were 37.9%， 24.2% and 24.2% respectively ( χ2=43.742， P<0.001). Conclusion The nomogram model constructed by tumor diameter≥50 mm，GTP≥36 U/L， MVI and portal vein invasion can accurately evaluate the risk of recurrence after hepatectomy in patients with PLC，and the patients in the high-risk group should be intervened as soon as possible.

Key Words:  Hepatocellular carcinoma; Liver cancer resection; Prognosis; Nomogram