综合炎症反应评分预测肝细胞癌患者经导管动脉化疗栓塞术后疼痛程度

摘要/Abstract

摘要： 目的整合中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）构建综合炎症反应评分（NLR-PLR score,NLR-PLRs）,并构建一种预测经导管动脉化疗栓塞术（transarterial chemoembolization,TACE）后疼痛程度的Nomogram模型。
方法：选取2017年1月至2021年12月于皖西卫生职业学院附属医院手术室治疗的170例不可切除的肝细胞癌（hepatocellular carcinoma,HCC）患者。按照1.5∶1的比例将170例患者随机分为测试集（n=102）和验证集（n=68）。根据NLR和PLR预测TACE后中度或重度疼痛的受试者操作特征（receiver operator characteristic,ROC）曲线分析结果构建NLR-PLRs。在测试集中采用多因素Logistic回归分析TACE后中度或重度疼痛的危险因素,并构建Nomogram模型。采用测试集和验证集数据评估Nomogram模型的预测性能。
结果：测试集中,TACE后中度或重度疼痛患者的NLR和PLR均高于TACE后无或轻度疼痛患者,且差异均有统计学意义（P<0.05）。ROC曲线显示,NLR和PLR预测TACE后中度或重度疼痛的曲线下面积（area under the curve,AUC）分别为0.700和0.764,最佳截断值分别为3.27和173.79。年龄<65岁、肿瘤最大直径≥5cm、肿瘤多发、有PVTT和NLR-PLRs越高的患者TACE后更有可能出现中度或重度疼痛。测试集数据中,一致性指数（consistency index,C-index）为0.847（95%CI：0.738~0.911）,AUC为0.866（95%CI：0.784~0.925）,Nomogram模型提供显著附加临床净收益且高于单个预测因子结果。验证集数据中,C-index为0.749（95%CI：0.629~0.847）,AUC为0.749（95%CI：0.629~0.847）,Nomogram模型提供显著附加临床净收益且高于单个预测因子结果。
结论：NLR-PLRs与TACE后中度或重度疼痛有关系。基于NLR-PLRs的Nomogram模型可为疼痛护理管理程序启动时机提供参考。

关键词: 肝细胞癌, 炎症, 经导管动脉化疗栓塞术, 疼痛, Nomogram模型

Abstract: Objective: The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was combined to construct a comprehensive inflammatory response score (named NLR-PLRs), followed by a nomogram model to predict the intensity of pain after transcatheter arterial chemoembolization (TACE).
Method: Totally 170 patients with unresectable hepatocellular carcinoma (HCC) treated in the Affiliated Hospital of Wanxi Health Vocational College operating room from January 2017 to December 2021 were selected. These patients were randomly divided into test set (n=102) and validation set (n=68) according to the ratio of 1.5:1. NLR-PLRs was constructed based on the receiver operator characteristic (ROC) curve analysis results for NLR and PLR predicting moderate or severe pain after TACE. Risk factors for moderate or severe pain after TACE were analyzed in the test set using multifactorial Logistic regression, and then a nomogram model was constructed. The predictive performance of the nomogram model was evaluated using test set and validation set data.
Result: In the test set, both NLR and PLR were higher in patients with moderate or severe pain after TACE than in patients with no or mild pain after TACE, and all differences were statistically significant (P<0.05). The ROC curves showed that the area under the curve (AUC) for NLR and PLR to predict moderate or severe pain after TACE was 0.700 and 0.764, with optimal cut-off values of 3.27 and 173.79, respectively. Age, maximum tumor diameter, number of tumors, portal venous tumor thrombus (PVTT), and NLR-PLRs were independent risk factors for moderate or severe pain after TACE (all P<0.05). In the test set, the consistency index (C-index) was 0.847 (95%CI: 0.738-0.911) and the AUC was 0.866 (95%CI: 0.784-0.925). The nomogram model provided a significant additional net clinical benefit over the individual predictor results. Similarly, C-index was 0.749 (95%CI: 0.629-0.847), and the AUC was 0.749 (95%CI: 0.629-0.847) in the validation set, while the nomogram model provided a significant additional net clinical benefit over the individual predictor results.
Conclusion: NLR-PLRs was associated with moderate or severe pain after TACE. The nomogram model based on NLR-PLRs may inform the timing of pain care management procedure initiation.

Key words: Hepatocellular carcinoma, Inflammation, Transarterial chemoembolization, Pain, Nomogram model

梁前静, 吴德平, 王胜杰, 严康明, 邓莉莉, 韩山山. 综合炎症反应评分预测肝细胞癌患者经导管动脉化疗栓塞术后疼痛程度[J]. 肝癌电子杂志, 2022, 9(3): 27-35.

Liang Qianjing, Wu Deping, Wang Shengjie, Yan Kangming, Deng Lili, Han Shanshan. Prediction of pain intensity after transarterial chemoembolization in patients with hepatocellular carcinoma by neutrophil to lymphocyte ratio-platelet to lymphocyte ratio score[J]. Electronic Journal of Liver Tumor, 2022, 9(3): 27-35.

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