关键词: 原发性肝癌, 增强CT扫描, 经导管肝动脉化疗栓塞术, 治疗效果, 列线图

Abstract: Objective To construct a predictive model based on quantitative parameters of contrast-enhanced CT for the efficacy of transcatheter arterial chemoembolization (TACE) on the treatment of patients with primary liver cancer (PLC). Methods A total of 117 PLC patients who underwent TACE treatment in Zhongda Hospital Affiliated to Southeast University and Dongtai Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were retrospectively selected. All patients underwent enhanced CT examination before operation, and the peak enhancement (PH), time to peak enhancement (Tp), perfusion value, and PH ratio of the mass to the aorta (M/A) were collected. At 3 months after operation, the patients were divided into an effective group (76 cases) and an ineffective group (41 cases) according to the efficacy. The clinical data of patients were collected, and the influencing factors of the treatment efficacy were analyzed. A nomogram prediction model was constructed based on the quantitative parameters of enhanced CT, and the area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the prediction efficiency of the model. Results The parameters of ineffective group vs. effective group were as the following: PH[(41.28±10.32) HU vs. (35.57±8.89) HU], M/A[(0.19±0.05) vs. (0.17±0.04)], perfusion value [(0.38±0.12) mL·min^-1·mL^-1 vs. (0.21±0.11) mL·min^-1·mL^-1], the values in the ineffective group were higher than those in the effective group (P<0.05). When compared the proportion of Chinese HCC staging plan (CNLC) as stage III [60.98% vs. 15.79%], the proportion of Child-Pugh grade B [60.98% vs. 40.79%], the proportion of multiple tumors [75.61% vs. 48.68%], the preoperative level of alpha-fetoprotein (AFP) [(534.62±81.95) ng/mL vs. (421.58±63.24) ng/mL], and the ratio of C-reactive protein/albumin (CAR) levels [(1.53±0.38 vs. (1.21±0.31)], the values of the ineffective group were higher than those in the effective group (P<0.05). By multivariate stepwise Logistic regression analysis it was showed that the perfusion value (OR=5.233, 95%CI: 2.261~12.107), CNLC stage (OR=6.561, 95%CI: 3.152~13.656), tumor number (OR=3.471, 95%CI: 1.269~9.487) and preoperative AFP level (OR=5.725, 95%CI: 3.105~10.552) were independent risk factors for the efficacy of patients (P<0.05). The C-index of the nomogram model based on the Logistic results was 0.834, and the correction of the predicted efficacy was close to the ideal curve (P>0.05). The ROC curve showed that the sensitivity of the model for predicting the efficacy of TACE treatment on PLC patients was 88.90%, the specificity was 91.70%, and the AUC was 0.899 (P<0.05). Conclusion The nomogram prediction model based on the perfusion values of contrast-enhanced CT quantitative parameters can better predict the efficacy of TACE on the treatment of PLC patients.

Key words: Primary liver cancer, Enhanced CT scan, Transcatheter arterial chemoembolization, The therapeutic effect, Nomogram