VAST评分对肝细胞癌右半肝切除术后显著性肝衰竭的预测价值研究

Research on the Predictive Value of VAST Score for Significant Liver Failure after Right Hemihepatectomy for Hepatocellular Carcinoma

摘要: 目的：探讨VAST评分对肝细胞癌右半肝切除术后显著性肝衰竭的预测价值。方法：回顾性分析206例行右半肝切除术的肝细胞癌患者的临床资料。通过单多因素Logistic回归分析确定肝细胞癌右半肝切除术后显著肝功能衰竭的独立预测因素，并建立列线图模型，采用Bootstrap等量有放回重复抽样1000次的方法进行内部验证。绘制受试者工作特征曲线(ROC曲线)、校准曲线、决策曲线评估模型性能，并与传统评分模型的预测效能进行对比。结果：多因素Logistic回归分析显示，VAST评分 ≥ 2分(OR= 4.480, P = 0.018)、残肝体积体重比降低(OR = 0.034, P = 0.004)、MELD评分增加(OR = 1.775, P = 0.001)是肝细胞癌右半肝切除术后显著肝功能衰竭的独立预测因素。列线图模型的受试者工作特征曲线下面积(AUC)为0.772，校准能力良好。通过比较ROC及临床决策曲线发现，列线图模型的预测效能和临床决策效益优于传统评分模型。结论：基于VAST评分 ≥ 2分、残肝体积体重比和MELD评分构建的列线图模型在预测肝细胞癌右半肝切除术后显著性肝衰竭方面具有一定的价值。

Abstract: Objective: To explore the predictive value of the VAST score for significant liver failure after right hemihepatectomy for hepatocellular carcinoma. Methods: The clinical data of 206 patients with hepatocellular carcinoma who underwent right hemihepatectomy were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to determine the independent predictors of significant liver failure after right hemihepatectomy for hepatocellular carcinoma, and a nomogram model was established. Internal validation was performed using the Bootstrap method with 1000 repeated samplings. The performance of the model was evaluated by drawing the receiver operating characteristic curve (ROC curve), calibration curve, and decision curve, and compared with the predictive efficacy of traditional scoring models. Results: Multivariate Logistic regression analysis showed that a VAST score ≥ 2 (OR = 4.480, P = 0.018), a decreased ratio of residual liver volume to body weight (OR = 0.034, P = 0.004), and an increased MELD score (OR = 1.775, P = 0.001) were independent predictors of significant liver failure after right hemihepatectomy for hepatocellular carcinoma. The area under the ROC curve (AUC) of the nomogram model was 0.772, and the calibration ability was good. By comparing the ROC and clinical decision curves, it was found that the predictive efficacy and clinical decision-making benefits of the nomogram model were superior to those of traditional scoring models. Conclusion: The nomogram model based on a VAST score ≥ 2, the ratio of residual liver volume to body weight, and the MELD score has certain value in predicting significant liver failure after right hemihepatectomy for hepatocellular carcinoma.