Jung Kyu Sik, Kim Ji Hong, Kim Seung Up, Song Kijun, Kim Beom Kyung, Park Jun Yong, Kim Do Young, Ahn Sang Hoon, Moon Do Chang, Song In Ji, Choi Gi Hong, Park Young Nyun, Han Kwang-Hyub
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea; Liver Cirrhosis Clinical Research Center, Seoul, Korea.
PLoS One. 2014 Jun 9;9(6):e99167. doi: 10.1371/journal.pone.0099167. eCollection 2014.
Preoperative liver stiffness (LS) measurement using transient elastography (TE) is useful for predicting late recurrence after curative resection of hepatocellular carcinoma (HCC). We developed and validated a novel LS value-based predictive model for late recurrence of HCC.
Patients who were due to undergo curative resection of HCC between August 2006 and January 2010 were prospectively enrolled and TE was performed prior to operations by study protocol. The predictive model of late recurrence was constructed based on a multiple logistic regression model. Discrimination and calibration were used to validate the model.
Among a total of 139 patients who were finally analyzed, late recurrence occurred in 44 patients, with a median follow-up of 24.5 months (range, 12.4-68.1). We developed a predictive model for late recurrence of HCC using LS value, activity grade II-III, presence of multiple tumors, and indocyanine green retention rate at 15 min (ICG R15), which showed fairly good discrimination capability with an area under the receiver operating characteristic curve (AUROC) of 0.724 (95% confidence intervals [CIs], 0.632-0.816). In the validation, using a bootstrap method to assess discrimination, the AUROC remained largely unchanged between iterations, with an average AUROC of 0.722 (95% CIs, 0.718-0.724). When we plotted a calibration chart for predicted and observed risk of late recurrence, the predicted risk of late recurrence correlated well with observed risk, with a correlation coefficient of 0.873 (P<0.001).
A simple LS value-based predictive model could estimate the risk of late recurrence in patients who underwent curative resection of HCC.
使用瞬时弹性成像（TE）术前测量肝脏硬度（LS）有助于预测肝细胞癌（HCC）根治性切除术后的晚期复发。我们开发并验证了一种基于新型LS值的HCC晚期复发预测模型。
前瞻性纳入2006年8月至2010年1月期间计划接受HCC根治性切除的患者，并按照研究方案在术前进行TE检查。基于多因素逻辑回归模型构建晚期复发预测模型。采用辨别力和校准来验证该模型。
最终分析的139例患者中，44例出现晚期复发，中位随访时间为24.5个月（范围12.4 - 68.1个月）。我们使用LS值、活动度II - III级、多肿瘤存在情况以及15分钟时的吲哚菁绿滞留率（ICG R15）建立了HCC晚期复发预测模型，该模型显示出相当好的辨别能力，受试者工作特征曲线下面积（AUROC）为0.724（95%置信区间[CI]，0.632 - 0.816）。在验证中，使用自助法评估辨别力，各次迭代间AUROC基本保持不变，平均AUROC为0.722（95% CI，0.718 - 0.724）。当绘制预测和观察到的晚期复发风险校准图时，预测的晚期复发风险与观察到的风险相关性良好，相关系数为0.873（P<0.001）。
一个简单的基于LS值的预测模型可以估计接受HCC根治性切除患者的晚期复发风险。
