Development and Validation of a Prediction Model for Short-Term Response to TACE Combined with Targeted and Immunotherapy in Patients with Hepatocellular Carcinoma from High-Altitude Areas

doi:10.3877/cma.j.issn.2095-5782.2026.02.006

Abstract

Abstract:

Objective

This study sought to construct a predictive model for the short-term efficacy of transarterial chemoembolization (TACE) combined with targeted-immunotherapy in hepatocellular carcinoma (HCC) patients residing in high-altitude regions, offering a reliable quantifiable tool for clinical efficacy assessment.

Methods

A total of 101 eligible HCC patients were retrospectively included. Clinical and imaging data were collected, and independent predictive factors were identified via univariate and multivariate logistic regression analyses. A nomogram model was established, with internal validation performed using 1 000 bootstrap resamplings. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibrated area under the curve (AUC), calibration curves, and decision curve analysis.

Results

Maximum tumor diameter (OR=1.598, 95% CI: 1.265-2.017, P<0.05), lack of tumor pseudocapsule (OR=12.588, 95% CI: 2.356-67.238, P<0.05), and lower minimum apparent diffusion coefficient (ADCmin, OR=0.333，95% CI: 0.194-0.569, P<0.05) were identified as independent predictors of short-term treatment response. After bootstrap validation, the model's calibrated AUC reached 0.953 (95% CI: 0.919-0.993), and a visualized nomogram was generated accordingly.

Conclusion

This predictive model serves as a reliable quantifiable tool for efficacy evaluation and personalized treatment decision-making in HCC patients from high-altitude regions.

Key words: Transcatheter Arterial Chemoembolization (TACE), Hepatocellular Carcinoma (HCC), High-Altitude Areas, Nomogram

Yanming Lei. Development and Validation of a Prediction Model for Short-Term Response to TACE Combined with Targeted and Immunotherapy in Patients with Hepatocellular Carcinoma from High-Altitude Areas[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(02): 164-170.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2026.02.006

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2026/V14/I02/164

Figures/Tables 8

靶免方案	CR	PR	SD	PD	计数
替雷利珠联合仑伐替尼	7	19	23	27	76
信迪利联合仑伐替尼	2	4	6	5	17
卡瑞利珠联合仑伐替尼	1	1	2	4	8
计数	10	24	31	36	101

项目	疾病控制组(65例)	疾病进展组(36例)	t/Z/χ²	P值
年龄(岁， $x ¯$ ±s)	55.66±9.63	57.78±10.69	-1.017	0.312
性别[例(%)]			0.346	0.556
女性	14(21.54)	6(16.67)
男性	51(78.46)	30(83.33)
BCLC分期[例(%)]			0.559	0.455
B	64(98.46)	36(100.00)
C	1(1.54)	0(0.00)
Child-Pugh [例(%)]			0.772	0.380
A	47(72.31)	23(63.89)
B	18(27.69)	13(36.11)
ECOG评分[例(%)]			0.559	0.455
0.0	64(98.46)	36(100.00)
1.0	1(1.54)	0(0.00)
乙肝病史[例(%)]			0.845	0.358
HBeAg阳性慢性HBV感染	20(30.77)	8(22.22)
HBeAg阴性慢性HBV感染	45(69.23)	28(77.78)
肝硬化[例(%)]			2.666	0.103
无	8(12.31)	9(25.00)
有	57(87.69)	27(75.00)
PT(s， $x ¯$ ±s)	14.43±1.62	14.66±1.53	-0.677	0.500
AFP [ng/mL，M(Q₁，Q₃)]	355.70(16.80,1 971.50)	851.8(54.00,5 069.00)	-1.429	0.153
ALT[U/L，M(Q₁，Q₃)]	40.00(26.00,67.00)	47.50(28.00,70.50)	-0.766	0.444
AST[U/L，M(Q₁，Q₃)]	46.00(29.50,74.00)	55.00(39.80,71.80)	-1.383	0.167
血浆白蛋白[g/L，M(Q₁，Q₃)]	35.30(31.80,38.00)	33.95(31.30,37.20)	-0.553	0.580
TBil[μmol/L，M(Q₁，Q₃)]	22.60(18.10,31.90)	20.25(13.10,28.40)	-1.588	0.112
假包膜[例(%)]			8.959	0.003
有	54(83.08)	20(55.56)
无	11(16.92)	16(44.44)
肿瘤最大径[cm，M(Q₁，Q₃)]	4.30(2.60,6.20)	9.10(5.50,12.00)	-4.865	<0.001
ADC Mean[×10^-3，M(Q₁，Q₃)]	0.98(0.90,1.10)	0.69(0.60,0.80)	-7.368	<0.001
ADC Max[×10^-3，M(Q₁，Q₃)]	1.39(1.20,1.50)	1.01(0.80,1.10)	-6.907	<0.001
ADC Min(×10^-3， $x ¯$ ±s)	0.72±0.20	0.41±0.19	7.672	<0.001

项目	疾病控制组(65例)	疾病进展组(36例)	t/Z/χ²	P值
年龄(岁， $x ¯$ ±s)	55.66±9.63	57.78±10.69	-1.017	0.312
性别[例(%)]			0.346	0.556
女性	14(21.54)	6(16.67)
男性	51(78.46)	30(83.33)
BCLC分期[例(%)]			0.559	0.455
B	64(98.46)	36(100.00)
C	1(1.54)	0(0.00)
Child-Pugh [例(%)]			0.772	0.380
A	47(72.31)	23(63.89)
B	18(27.69)	13(36.11)
ECOG评分[例(%)]			0.559	0.455
0.0	64(98.46)	36(100.00)
1.0	1(1.54)	0(0.00)
乙肝病史[例(%)]			0.845	0.358
HBeAg阳性慢性HBV感染	20(30.77)	8(22.22)
HBeAg阴性慢性HBV感染	45(69.23)	28(77.78)
肝硬化[例(%)]			2.666	0.103
无	8(12.31)	9(25.00)
有	57(87.69)	27(75.00)
PT(s， $x ¯$ ±s)	14.43±1.62	14.66±1.53	-0.677	0.500
AFP [ng/mL，M(Q₁，Q₃)]	355.70(16.80,1 971.50)	851.8(54.00,5 069.00)	-1.429	0.153
ALT[U/L，M(Q₁，Q₃)]	40.00(26.00,67.00)	47.50(28.00,70.50)	-0.766	0.444
AST[U/L，M(Q₁，Q₃)]	46.00(29.50,74.00)	55.00(39.80,71.80)	-1.383	0.167
血浆白蛋白[g/L，M(Q₁，Q₃)]	35.30(31.80,38.00)	33.95(31.30,37.20)	-0.553	0.580
TBil[μmol/L，M(Q₁，Q₃)]	22.60(18.10,31.90)	20.25(13.10,28.40)	-1.588	0.112
假包膜[例(%)]			8.959	0.003
有	54(83.08)	20(55.56)
无	11(16.92)	16(44.44)
肿瘤最大径[cm，M(Q₁，Q₃)]	4.30(2.60,6.20)	9.10(5.50,12.00)	-4.865	<0.001
ADC Mean[×10^-3，M(Q₁，Q₃)]	0.98(0.90,1.10)	0.69(0.60,0.80)	-7.368	<0.001
ADC Max[×10^-3，M(Q₁，Q₃)]	1.39(1.20,1.50)	1.01(0.80,1.10)	-6.907	<0.001
ADC Min(×10^-3， $x ¯$ ±s)	0.72±0.20	0.41±0.19	7.672	<0.001

临床影像特征	回归系数	标准误	Z值	P值	OR（95% CI）
肿瘤最大径	0.469	0.119	3.936	<0.001	1.598(1.265-2.017)
ADC Min	-1.101	0.274	-4.018	<0.001	0.333(0.194-0.569)
无假包膜	2.533	0.855	2.963	0.003	12.588(2.356-67.238)
截距	1.612	1.478	1.091	0.275	5.015(0.277-90.884)

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