原发性肝癌肝切除术后复发危险因素分析

Analysis of Risk Factors for Recurrence of Primary Liver Cancer after Hepatectomy

摘要: 目的：综合分析影响原发性肝癌肝切除术后复发的危险因素，并构建临床预测模型，为早期识别高危患者及制定个体化治疗策略提供依据。方法：回顾性收集2019年1月至2023年12月期间接受肝切除术的326例原发性肝癌患者的临床病理资料。采用Kaplan-Meier法计算累积复发率，Log-rank检验进行单因素分析。采用Cox比例风险回归模型进行多因素分析并筛选独立危险因素。基于独立危险因素构建列线图预测模型，通过一致性指数(C-index)、校准曲线和决策曲线分析(DCA)评估模型性能。结果：中位随访38个月期间，326例患者中共149例出现复发，总体复发率为45.7%。多因素Cox回归分析显示，肿瘤直径 > 5 cm (HR = 2.14,95% CI: 1.48~3.09)、肿瘤数目 ≥ 2个(HR = 1.92, 95% CI: 1.32~2.79)、微血管侵犯(MVI) (HR = 2.56, 95% CI: 1.78~3.68)、存在卫星灶(HR = 1.98, 95% CI: 1.35~2.91)、术前AFP > 400 μg/L (HR = 1.67, 95% CI: 1.18~2.36)及非解剖性肝切除(HR = 1.58, 95% CI: 1.12~2.23)是术后复发的独立危险因素(均p < 0.05)。亚组分析显示，早期复发主要与肿瘤侵袭性因素相关，晚期复发则与基础肝病背景更相关。构建的列线图模型C-index为0.812，校准度和决策曲线均显示出良好的临床预测效能与净收益。结论：原发性肝癌肝切除术后复发率较高。MVI、肿瘤负荷指标、AFP水平及非解剖性肝切除是复发的独立危险因素。基于这些因素构建的列线图模型有助于个体化预测复发风险。

Abstract: Objective: This paper aims to comprehensively analyze the risk factors affecting the recurrence of primary liver cancer after hepatectomy, and to construct a clinical prediction model to provide a basis for early identification of high-risk patients and formulation of individualized treatment strategies. Methods: The clinicopathological data of 326 patients with primary liver cancer who underwent hepatectomy from January 2019 to December 2023 were retrospectively collected. The cumulative recurrence rate was calculated using the Kaplan-Meier method, and univariate analysis was performed using the Log-rank test. The Cox proportional hazards regression model was used for multivariate analysis to screen for independent risk factors. A nomogram prediction model was constructed based on the independent risk factors, and its performance was evaluated by the concordance index (C-index), calibration curve, and decision curve analysis (DCA). Results: During a median follow-up of 38 months, 149 of 326 patients experienced recurrence, with an overall recurrence rate of 45.7%. Multivariate Cox regression analysis showed that tumor diameter > 5 cm (HR = 2.14, 95% CI: 1.48~3.09), tumor number ≥ 2 (HR = 1.92, 95% CI: 1.32~2.79), microvascular invasion (MVI) (HR = 2.56, 95% CI: 1.78~3.68), satellite nodules (HR = 1.98, 95% CI: 1.35~2.91), preoperative AFP > 400 μg/L (HR = 1.67, 95% CI: 1.18~2.36), and non-anatomical hepatectomy (HR = 1.58, 95% CI: 1.12~2.23) were independent risk factors for postoperative recurrence (all p < 0.05). Subgroup analysis revealed that early recurrence was mainly associated with tumor invasiveness factors, whereas late recurrence correlated more with the underlying liver disease background. The C-index of the constructed nomogram model was 0.812. Both the calibration and decision curves indicated good clinical predictive efficacy and net benefit. Conclusion: The recurrence rate of primary liver cancer after hepatectomy is relatively high. MVI, tumor burden indicators, AFP levels, and non-anatomical hepatectomy are independent risk factors for recurrence. The nomogram model constructed based on these factors facilitates individualized prediction of recurrence risk.