晚期肝细胞癌经动脉化疗栓塞术后栓塞综合征风险网络计算器及预后分析

摘要/Abstract

摘要： 目的: 分析晚期肝细胞癌（HCC）首次经动脉化疗栓塞术（TACE）后栓塞综合征（PES）对预后影响,并分析PES危险因素和构建风险评估网络计算器。
方法: 选取六安市中医院2020年1月至2022年9月首次TACE治疗的晚期HCC患者。采用Kaplan-Meier法生存分析,采用单因素和多因素Cox比例风险回归模型分析患者死亡危险因素。采用多因素Logistic回归模型分析PES危险因素,基于PES危险因素构建晚期PES风险列线图。采用内部数据集进行校正曲线、决策曲线和临床影响曲线分析,并将列线图发布至网站中构建风险评估网络计算器。
结果: 147例晚期HCC患者首次TACE后PES发生率为62.6%。TACE后平均随访时间（12.42±3.58）个月,其中99例（67.3%）患者死亡。PES患者总生存率低于非PES患者（P<0.05）。多因素Cox比例风险回归模型分析显示PES、TACE次数和联合治疗是晚期HCC患者预后的独立危险因素（均P<0.05）。多因素Logistic回归分析结果显示年龄、最大肿瘤直径、药物递送途径、总胆红素（TB）和白蛋白（ALB）是PES独立风险因素（均P<0.05）。构建预测晚期HCC患者首次TACE后PES的列线图并可视化为网络计算器操作界面,受试者操作特征曲线下面积为0.863（0.796~0.914）,校正曲线显示C-index为0.879,表明网络计算器具有较高预测准确性。
结论: PES与TACE后晚期HCC患者生存率降低相关。基于年龄、最大肿瘤直径、药物递送方法、TB和ALB构建的PES风险网络计算器能为采取更为积极的措施管理PES提供参考依据。

关键词: 晚期, 肝细胞癌, 经动脉化疗栓塞术, 栓塞综合征, 网络计算器, 预后

Abstract: Objective: To analyse the prognostic impact of post-embolisation syndrome (PES) after first transarterial chemoembolisation (TACE) for advanced hepatocellular carcinoma (HCC), and to analyse the risk factors for PES and construct a risk assessment network calculator.
Methods: Patients with advanced HCC treated with first TACE between January 2020 and September 2022 in our hospital were selected. Kaplan-Meier method were used to survival analysis, and unifactorial and multifactorial Cox risk regression were used to analyse patients' risk factors for death. Multifactorial logistic regression model was used to analyse PES risk factors, column line graphs of advanced PES risk were constructed based on PES risk factors, internal dataset was used for calibration curves, decision curves, and clinical impact curves analysis, and column line graphs were published into Netwatch to construct the Risk Assessment Network Calculator.
Results: The incidence of PES after the first TACE was 62.6% in 147 patients with advanced HCC.The mean follow-up time after TACE was (12.42 ± 3.58) months, of which 99 (67.3%) patients died.The overall survival rate of patients with PES was lower than that of patients with non-PES (P<0.05). Multifactorial Cox proportional risk regression showed that PES, number of TACE and combination therapy were independent risk factors for prognosis in patients with advanced HCC (all P<0.05). Multifactorial logistic regression analysis showed that age, maximum tumour diameter, drug delivery route, total bilirubin (TB) and albumin (ALB) were independent risk factors for PES (all P<0.05). The area under the curve of the receiver operating characteristic curve - curve of the predicted PES risk nomogram was 0.863 (0.796-0.914), and the calibration curve showed a C-index of 0.879, which indicated that the nomogram had a high predictive accuracy.
Conclusions: PES is associated with reduced survival in patients with advanced HCC after TACE. A PES risk network calculator based on age, maximum tumour diameter, drug delivery method, TB and ALB can provide a reference basis for more active measures to manage PES.

Key words: Advanced, Hepatocellular carcinoma, Transarterial chemoembolisation, Embolisation syndrome, Network calculator, Prognosis

陈艳, 田启凤, 陈诚, 田水林. 晚期肝细胞癌经动脉化疗栓塞术后栓塞综合征风险网络计算器及预后分析[J]. 肝癌电子杂志, 2025, 12(1): 33-38.

Chen Yan, Tian Qifeng, Chen Cheng, Tian Shuilin. Risk network calculators and prognosticators for Embolic syndrome after TACE in hepatocellular carcinoma[J]. Electronic Journal of Liver Tumor, 2025, 12(1): 33-38.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] PAN Y, CHANG R, HE Z, et al.How to prophylactically alleviate postembolization syndrome following transarterial chemoembolization?: protocol of a double blinded, randomized, placebo-controlled trial[J]. Medicine (Baltimore), 2021, 100(14): e25360.
[3] HE J J, YIN X X, WANG T, et al.Factors influencing postembolization syndrome in patients with hepatocellular carcinoma undergoing first transcatheter arterial chemoembolization[J]. J Cancer Res Ther, 2021, 17(3): 777-783.
[4] CHANG K T, LIU C J, TSAI H T, et al.Effects and safety of body positioning on back pain after transcatheter arterial chemoembolization in people with hepatocellular carcinoma: a randomized controlled study[J]. Int J Nurs Stud, 2020, 109: 103641.
[5] SIMASINGHA N, TANASOONTRARAT W, CLAIMON T, et al.Efficacy of dexamethasone and N-acetylcysteine combination in preventing post-embolization syndrome after transarterial chemoembolization in hepatocellular carcinoma[J]. World J Gastroenterol, 2023, 29(5): 890-903.
[6] VANANI N B, JANARDAN A, ASMI N, et al.Post-embolization syndrome following Yttrium-90 radiation segmentectomy[J]. Cureus, 2023, 15(3): e35947.
[7] ROEHLEN N, STOEHR F, MÜLLER L, et al. Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis[J]. Hepatol Commun, 2023, 7(10): e0252.
[8] BAI J, HUANG M, ZHOU J, et al.Development of a predictive nomogram for postembolization syndrome after transcatheter arterial chemoembolization of hepatocellular carcinoma[J]. Sci Rep, 2024, 14(1): 3303.
[9] YU X, WANG F, YANG L, et al.Development and validation of web-based dynamic nomograms predictive of disease-free and overall survival in patients who underwent pneumonectomy for primary lung cancer[J]. Peer J, 2023, 11: e15938.
[10] GUAN Y, TIAN Y, FAN Y W.Pain management in patients with hepatocellular carcinoma after transcatheter arterial chemoembolisation: a retrospective study[J]. World J Gastrointest Surg, 2023, 15(3): 374-386.
[11] HASSANIN T M, FOUAD Y, HASSNINE A, et al.Quality of life after transcatheter arterial chemoembolization combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma compared with transcatheter arterial chemoembolization alone[J]. Asian Pac J Cancer Prev, 2021, 22(4): 1255-1261.
[12] CHAN P, GARCIA-REYES K, CRONAN J, et al.Managing postembolization syndrome-related pain after uterine fibroid embolization[J]. Semin Intervent Radiol, 2021, 38(3): 382-387.
[13] 彭冲,卢芳燕,孙军辉. 基于快速康复外科的多模式镇痛在肝动脉化疗栓塞术中的应用[J/CD]. 中华介入放射学电子杂志,2021,9(2):215-219.
[14] CHO Y, CHOI J W, KWON H, et al.Research Committee of the Korean Liver Cancer Association. Transarterial chemoembolization for hepatocellular carcinoma: 2023 Expert consensus-based practical recommendations of the Korean Liver Cancer Association[J]. Clin Mol Hepatol, 2023, 29(3): 521-541.
[15] THANAKUNCHAI T, HONGTHANAKORN C.Prevalence and riskfactors of post-chemoembolization syndrome after chemo-embolization for hepatocellular carcinoma in Thailand[J]. Dig Dis Sci, 2023, 68(9): 3818-3823.
[16] SHIM J H, PARK J W, CHOI J I, et al.Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma?[J]. J Vasc Interv Radiol, 2009, 20(2): 209-216.
[17] YUN C W, KIM H J, LIM J H, et al.Heat shock proteins: agents of cancer development and therapeutic targets in anti-cancer therapy[J]. Cells, 2019, 9(1): 60.
[18] KHALAF M H, SUNDARAM V, ABDELRAZEK MOHAMMED M A, et al. A predictive model for postembolization syndrome after transarterial hepatic chemoembolization of hepatocellular carcinoma[J]. Radiology, 2019, 290(1): 254-261.
[19] PACHEV A, RAYNAUD L, PAULATTO L, et al.Predictive factors of severe abdominal pain during and after transarterial chemoembolization for hepatocellular carcinoma[J]. Eur Radiol, 2021, 31(5): 3267-3275.
[20] 尹西西,王婷,陈敏英,等. 原发性肝癌经皮肝动脉化疗栓塞术后患者栓塞后综合征发生现状及影响因素研究[J]. 护士进修杂志,2022,37(8):749-753.
[21] QIN H, XIAO X, YA H, et al.Nomogram for predicting severe abdominal pain after initial conventional transarterial chemoembolisation for hepatocellular carcinoma: a retrospective study[J]. Sci Rep, 2023, 13(1): 22397.
[22] KASHFI S, MURDAKHAYEV E, REHMANI R, et al.Post-embolization syndrome complicated by hypertensive emergency and severely elevated transaminases[J]. Cureus, 2021, 13(6): e15446.
[23] ANDREOZZI G, LORENZONI V, BARGELLINI I, et al.Drug-eluting microspheres compared to conventional transarterial chemoembolization as first line treatment for unresectable hepatocellular carcinoma: a single-center retrospective cost-utility analysis[J]. Cardiovasc Intervent Radiol, 2023, 46(3): 319-326.
[24] SEYED KHOEI N, WAGNER K H, CARRERAS-TORRES R, et al.Associations between prediagnostic circulating bilirubin levels and risk of gastrointestinal cancers in the UK biobank[J]. Cancers (Basel), 2021, 13(11) :2749.
[25] XU J, AN S, LU Y, et al.Preoperative alpha fetoprotein, total bilirubin, fibrinogen, albumin, and lymphocytes predict postoperative survival in hepatocellular carcinoma[J]. Cancer Med, 2023, 12(12): 13319-13328.
[26] LI H, WANG L, CHEN L, et al.Prognostic value of albumin-to-alkaline phosphatase ratio in hepatocellular carcinoma patients treated with liver transplantation[J]. J Cancer, 2020, 11(8): 2171-2180.
[27] TIAN Y, MA L, ZHANG P, et al.Prognostic value of systemic immune-inflammation index/ albumin for transcatheter arterial chemoembolization treatment[J]. Heliyon, 2023, 9(4): e15156.
[28] JALALI A, ALVAREZ-IGLESIAS A, ROSHAN D, et al.Visualising statistical models using dynamic nomograms[J]. PLoS One, 2019, 14(11): e0225253.
[29] 陈丽容,韦琼珍,黄银英,等. 协同护理干预对肝癌TACE患者肝功能和栓塞综合征的影响[J]. 中国卫生标准管理,2023,14(18):177-181.