术前NETs和PLR对肝癌肝移植术后早期复发的预测价值:基于多中心队列的列线图模型构建与验证OA

Objective To construct and verify the predictive value of a nomogram model based on preoperative neutrophil extracellular traps(NETs)and platelet-lymphocyte ratio(PLR)for early recurrence after liver transplantation for liver cancer.Methods 200 HCC patients who received liver transplantation in Beijing You'an Hospital Affiliated to Capital Medical University from April 2021 to April 2024 were prospectively selected as training set,and the clinical data of 300 patients with liver cancer who received liver transplantation in different medical centers(Beijing You'an Hospital Affiliated to Capital Medical University,Xuanwu Hospital of Capital Medical University and People's Hospital of Peking University)from April 2022 to March 2024 were retrospectively collected as the validation set.Baseline data of enrolled patients were collected,including demographic characteristics,pathological data and laboratory parameters,among which NETs were determined by enzyme-linked immunosorbent assay,platelet count and lymphocyte count were automatically determined by blood cell analyzer,and PLR was calculated.Follow-up for 12 months after surgery,the recurrence of the training set and validation set were recorded.The independent predictors of early recurrence after liver transplantation were screened by univariate and multivariate Logistic regression analysis,and the nomogram model was constructed.Hosmer-Lemeshow test,receiver operating character(ROC)curve,and decision curve analysis to evaluate nomogram model calibration,discrimination,and clinical benefit.Validation set data were used to validate the predictive power of the nomogram models.Results The early recurrence rates of liver cancer patients after liver transplantation in the training set and validation set were approximately 20.00%(40/200)and 20.00%(60/300)respectively.Univariate analysis showed that there were significant differences in tumor diameter≥5 cm,low differentiation of tumor,microvascular invasion ratio,AFP,NETs and PLR between the relapsed and non-relapsed groups(P<0.05).Multivariate Logistic regression analysis showed that tumor diameter≥5 cm,low differentiation of tumor,microvascular invasion,AFP≥400 ng/mL,NETs≥68 ng/L,PLR≥70 were independent risk factors of early recurrence after liver transplantation in the training set(P<0.05).A nomogram model was constructed based on 6 independent risk factors of early recurrence after liver transplantation in the training set,ROC curve showed area under curve(AUC),sensitivity and specificity were 0.885(95%CI 0.727 to 0.954),89.50%and 77.60%,respectively.Validation set data were used to validate the nomogram model of early recurrence after liver transplantation in the training set,ROC curve showed AUC,sensitivity and specificity were 0.890(95%CI 0.725 to 0.968),88.00%and 74.50%respectively.Hosmer-Lemeshow test showed that there was no statistical significance between the predicted values and actual values in training set and validation set(χ2=1.705,1.425,all P>0.05).Conclusion Preoperative NETs and PLR are independent predictors of early recurrence after liver transplantation.The nomogram model based on NETs and PLR has a good predictive power in both the training set and validation set,and could be used to screen patients with high risk of recurrence after liver transplantation and provide basis for adjuvant therapy stratification.