收稿日期: 2025-05-27
网络出版日期: 2025-08-28
基金资助
国家中医优势专科(外科)项目(国中医药医政函[2024]90号);郑州市医疗卫生领域科技创新指导计划项目(2024YLZDJH070)
Constructing a Nomogram prediction model for early recurrence of hepatocellular carcinoma radical hepatectomy based on CT imaging omics and traditional Chinese medicine tongue image features
Received date: 2025-05-27
Online published: 2025-08-28
目的 基于CT影像组学与中医舌象特征构建肝细胞癌(HCC)根治术后早期复发的Nomogram风险预测模型。 方法 选取2018年9月至2022年9月在医院进行HCC根治术的216例患者,对其临床资料进行回顾性分析。按7:3比例随机将患者分为建模集(n = 152)和验证集(n = 64),记录两组术后1年复发情况。以建模集患者数据构建复发预测模型,患者术后均行平扫联合增强CT检查,提取影像组学特征指标,记录舌象特点,采用Cox多因素模型分析建模集患者术后复发的相关因素,构建风险预测模型。以验证集数据对模型进行验证。 结果 建模集患者1年复发52例,复发率34.21%;验证集患者1年复发23例,复发率35.94%。Cox多因素模型分析显示,Rad-score、舌质及舌形是HCC术后复发的独立影响因素(P < 0.05),基于此建立Nomogram列线图,ROC分析显示,列线图模型判断建模集与验证集患者术后复发的AUC分别为0.811和0.824,敏感度分别为0.875和0.833,特异度分别为0.617和0.750。 结论 HCC根治术后早期复发与Rad-score、舌质及舌形相关,基于此构建的Nomogram预测模型,对判断术后早期复发具有较高准确性。
王兆阳 , 张楠 . 基于CT影像组学与中医舌象特征构建肝细胞癌根治术后早期复发的Nomogram预测模型[J]. 实用医学杂志, 2025 , 41(16) : 2590 -2596 . DOI: 10.3969/j.issn.1006-5725.2025.16.022
Objective To construct a Nomogram risk prediction model for early recurrence of hepatocellular carcinoma (HCC) radical hepatectomy based on CT imaging omics and traditional Chinese medicine tongue imaging features. Methods 216 patients who underwent HCC radical hepatectomy in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from September 2018 to September 2022 were selected,the clinical dataes were retrospective analyzed.The patients were randomly divided into modeling set (n = 152) and validation set (n = 64) by 7:3 ratio,the recurrence situation one year after surgery of the two groups were recorded.A recurrence prediction model was constructed by the modeling set of patient dataes, all patients underwent postoperative plain scan combined with enhanced CT examination, and the Imaging omics feature indicators was extracted, the tongue imaging characteristics was recorded,the Cox multivariate model was used to analyze the factors related to postoperative recurrence in the modeling set of patients, and a risk prediction model was constructed,the model was validated by validation set dataes. Results There were 52 patients in the modeling set experienced recurrence within 1 year, the recurrence rate was 34.21%;there were 23 cases of recurrence in the validation set patients within 1 year, the recurrence rate was 35.94%.The Cox multivariate model analysis showed that the Rad-score, Tongue texture and tongue shape were independent influence factors for postoperative recurrence of HCC (P < 0.05). Based on this, the Nomogram column chart was established.The ROC analysis showed that the AUC of the column chart model for predicting postoperative recurrence in the modeling set and validation set patients were 0.811 and 0.824, the sensitivities were 0.875 and 0.833 respectively, the specificities were 0.617 and 0.750 respectively. Conclusions The early postoperative recurrence of HCC is related to Rad score, tongue texture, and tongue shape. Based on this, the Nomogram prediction model constructed has high accuracy in predicting early postoperative recurrence.
| [1] | 杨帆,曹毛毛,李贺,等. 1990—2019年中国人群肝癌流行病学趋势分析及预测[J]. 中华消化外科杂志,2022,21(1):106-113. doi:10.3760/cma.j.cn115610-20211203-00616 |
| [2] | HUO T I, HO S Y, LIAO J I.Predicting post‐resection early recurrence of hepatocellular carcinoma: Defining the role of microvascular invasion[J].Liver Int, 2023, 43(12):2826-2827. doi:10.1111/liv.15743 |
| [3] | 朱荣火,黄晶晶,黄鸿娜,等. 肝细胞癌切除术后早期复发的危险因素[J]. 实用肿瘤杂志,2023,38(4):377-381. doi:10.13267/j.cnki.syzlzz.2023.060 |
| [4] | 戴聪,刘文源,刘宣彤,等. 肝细胞癌影像特征结合实验室指标在微血管侵犯中的预测价值[J]. 中国医科大学学报,2024,53(1):75-79. |
| [5] | 冯宇,周曼丽,王健章,等. 中医舌诊方法现代研究进展[J]. 陕西中医,2020,41(6):838-840. |
| [6] | 王宇立,方媛,徐静,等. 原发性肝癌患者高强度聚焦超声治疗前后舌象、脉象参数及中医体质变化[J]. 中华中医药杂志,2020,35(12):6313-6317. |
| [7] | 杨晓蕾,杨超,张钦婷,等. 恶性肿瘤患者中医体质类型相关研究[J]. 辽宁中医药大学学报,2015,17(8):164-166. |
| [8] | 周铖,赵文霞,贾冉,等. 原发性肝癌肝胆湿热证与肝郁脾虚证患者舌苔菌群特征及功能差异[J]. 中华中医药杂志,2023,38(6):2861-2867. |
| [9] | ZHAO C, NGUYEN M H.Hepatocellular carcinoma screening and surveillance: Practice guidelines and real-life practice[J].J Clin Gastroenterol, 2016, 50(2):120-133. doi:10.1097/mcg.0000000000000446 |
| [10] | WEN J, WANG X, XIA M,et al.Radiomics features based on dual-area CT predict the expression levels of fatty acid binding protein 4 and outcome in hepatocellular carcinoma[J].Abdom Radiol, 2024, 49(6):1905-1917. doi:10.1007/s00261-023-04177-5 |
| [11] | 王晓东,周翼,靳涛,等. 肝癌腹腔镜根治术后PCIA并胸椎旁神经阻滞的效果[J]. 青岛大学学报(医学版),2024,60(4):565-569. |
| [12] | 张振奇,贺莉. 弥散加权成像联合动态对比增强磁共振成像在肝细胞肝癌患者肝动脉化疗栓塞术后肿瘤活性检测中的应用价值[J]. 陕西医学杂志,2024,53(6):773-776,781. |
| [13] | 王秀香,李海霞,郭琳,等. 微球TACE对小肝癌治疗的影响及相关因素分析[J]. 药物生物技术,2024,31(1):45-52. |
| [14] | NICOLAS M, CZERWONKO M, ARDILES V,et al.Laparoscopic vs open liver resection for metastatic colorectal cancer: Analysis of surgical margin status and survival[J].Langenbecks Arch Surg, 2022, 407(3):1113-1119. doi:10.1007/s00423-021-02396-2 |
| [15] | 周晨阳,周江敏,胡新昇,等.肝细胞癌患者术后早期复发的危险因素分析及风险评估模型构建[J].中国普通外科杂志, 2020, 29(8):973-978. |
| [16] | 史瑞籽,杨培,曾新桃,等. 腹腔镜肝细胞癌根治风险预测模型的建立与验证[J]. 腹腔镜外科杂志,2023,28(6):433-438,443. |
| [17] | LEE H, CHANG W, KIM H Y,et al.Improving radiomics reproducibility using deep learning-based image conversion of CT reconstruction algorithms in hepatocellular carcinoma patients[J].Eur Radiol,2024, 34(3):2036-2047. doi:10.1007/s00330-023-10135-y |
| [18] | MAO B, MA J, DUAN S,et al.Preoperative classification of primary and metastatic liver cancer via machine learning-based ultrasound radiomics[J].Eur Radiol, 2021,31(7):4576-4586. doi:10.1007/s00330-020-07562-6 |
| [19] | ZHANG T, DONG X, ZHOU Y,et al.Development and validation of a radiomics nomogram to discriminate advanced pancreatic cancer with liver metastases or other metastatic patterns.[J].Cancer Biomark, 2021,32(4):541-550. doi:10.3233/CBM-210190 |
| [20] | LIGERO M, JORDI-OLLERO O, BERNATOWICZ K, et al.Minimizing acquisition-related radiomics variability by image resampling and batch effect correction to allow for large-scale data analysis[J].Eur Radiol,2021, 31(3):1460-1470. doi:10.1007/s00330-020-07174-0 |
| [21] | LI W, ZHANG L, TIAN C,et al.Prognostic value of computed tomography radiomics features in patients with gastric cancer following curative resection[J].Eur Radiol, 2019, 29(6):3079-3089. doi:10.1007/s00330-018-5861-9 |
| [22] | ZHUANG Y Y, FENG Y, KONG D,et al.Discrimination between benign and malignant gallbladder lesions on enhanced CT imaging using radiomics[J].Acta Radiol, 2024,65(5):422-431. doi:10.1177/02841851241242042 |
| [23] | HECTORS S J, CHERNY M, YADAV K K,et al.Radiomics features measured with multiparametric MRI predict prostate cancer aggressiveness[J].J Urol, 2019, 202(3):498-505. doi:10.1097/ju.0000000000000272 |
| [24] | 胡泽玉,周铖,杨清瑞,等. 原发性肝癌患者经肝动脉化疗栓塞术后舌苔菌群变化特征研究[J]. 中国微生态学杂志,2023,35(3):263-268. |
| [25] | 邵峰,曾普华,曾光,等. 基于临床数据分析原发性肝癌的证治规律[J]. 湖南中医药大学学报,2019,39(1):40-44. doi:10.3969/j.issn.1674-070X.2019.01.010 |
| [26] | 陈建杰. 肝癌中医药辨治思路[J]. 中西医结合肝病杂志,2019,29(2):109-111. |
| [27] | 徐巧笑,胡振斌,莫莎莎,等. 从"虚、毒、瘀"浅谈原发性肝癌病机和治疗[J]. 陕西中医,2023,44(10):1431-1434. |
| [28] | 邢金山,王立森,孙逊,等. 原发性肝癌中医四诊辨证诊疗临床观察[J]. 社区医学杂志,2019,17(18):1130-1134. |
| [29] | 杨晗,陈淑琪,陈继欣,等. 原发性肝癌肝动脉化疗栓塞术前后中医证素的变化特点研究[J]. 中医药导报,2020,26(10):105-108. |
| [30] | 谢武,何云,易敏铭. 刘辉华教授辨证论治肝病经验总结[J]. 贵州医药,2024,48(12):1943-1945. |
| [31] | 彭进,贾燕华,李宏. 原发性肝癌CT影像学特征与中医辨证分型的关系研究[J]. 四川中医,2021,39(10):57-60. |
| [32] | 高逸云,詹欣雨,周浩明.内质网应激调控巨噬细胞免疫应答在肝脏疾病中的作用[J].器官移植,2024,15(6):889-894. |
/
| 〈 |
|
〉 |