| ObjectiveObjective To investigate the effects of obesity,Nonalcoholic Steatohepatitis(NASH)and other related factors on the risk of Primary Hepatic Carcinoma(PHC).The risk prediction model of PHC occurrence was established to provide theoretical basis for effective prevention and treatment in the future.MethodsIn this study,a total of 2772 subjects were enrolled from a hospital in Anhui Province from January 1,2019 to December 31,2021 according to the "Norms for the Diagnosis and Treatment of Primary Liver Cancer(2011 Edition)" and the inclusion and exclusion criteria.Among them,305 newly diagnosed PHC patients from January 1,2019 to December 31,2019 were included in the validation cohort;1017 newly diagnosed PHC patients from January 1,2020 to December 31,2021 were included in the training cohort,Stratified sampling was used to select 1088 healthy subjects formed the control group.Gender,age,Body Mass Index(BMI),NASH,hepatitis B,cirrhosis,type 2 diabetes,and family history of liver cancer were collected.SPSS20.0 and R language 3.6.3 were used for statistical analysis.Firstly,Chi-square test was used to compare the differences among each factor group.Multivariate logistic regression analysis was used to screen out the risk factors for PHC,and determine whether obesity was an independent risk factor for PHC,and stratified analysis was conducted according to whether NASH,And to further analyze the influence of NASH on the risk of PHC in obese people.Secondly,the PHC risk prediction model was established based on logistic regression analysis,and the PHC risk prediction line graph was developed on the basis of this model.Finally,use the likelihood ratio test,Hosmer-Lemeshow goodness of fit test,AUC index and calibration curve were used to evaluate the fit degree,differentiation degree and calibration degree of the PHC risk prediction model.Analyze the predictive power of the model.The P values of all tests were bilateral.Inspection level α=0.05.Results1.The differences between the two groups in gender,among the 1017 cases in the case group and 1088 cases in the control group included in this study.age,hepatitis B,cirrhosis,type 2 diabetes,family history of liver cancer,obesity and NASH were statistically significant(P<0.05),and the corresponding Chi-square values were:7.42,22.89,18.44,26.77,4.99,4.64,11.78,28.06.2.Multivariate Logistic regression analysis showed that age(OR=1.368,95%CI:1.296-3.725),obesity(OR=1.576,95%CI:1.132-2.653),NASH(OR=1.127,95%CI:1.038-2.667),hepatitis B(OR=1.873,95%CI:1.105-3.659),type 2 diabetes(OR=1.532,95%CI:1.231-3.759),and family history of liver cancer(OR=1.649,95%CI:1.184-2.857)Six variables were independent risk factors for the occurrence of PHC(P<0.05),among which the incidence of PHC in obese patients was 1.576 times that of non-obese patients,and the risk of PHC in obese patients was higher than that in non-obese patients.3.The results of stratified analysis were stratified by NASH,including 173 patients with PHC and 92 patients without PHC in the context of NASH.There were 844 patients with PHC and 996 patients without PHC in the context of without NASH.When only obesity and NASH were considered,OR=2.604 before stratification,ORNASH+=2.969 after stratification,ORNASH-=1.993,ORMH=2.209,X2MH=12.384,ORMH was lower than OR before stratification.The results showed that NASH enhanced the strength of association between obesity and PHC(P<0.05).In addition,the results of multivariate analysis after stratification showed that age,obesity,hepatitis B,type 2 diabetes,and family history of liver cancer were all independent risk factors for the occurrence of PHC in NASH patients,among which obesity OR value was the highest,and the incidence of PHC in obese patients was 2.528 times that of non-obese patients(OR=2.528,95%CI:1.913-3.366);In the absence of NASH,age,obesity,family history of hepatitis B and liver cancer were independent risk factors for PHC,and the incidence of PHC in obese patients was 1.247 times higher than that in non-obese patients(OR=1.247,95%CI:1.056-3.279).All layers showed that obesity was an independent risk factor for PHC(P<0.05).4.Based on Logistic regression analysis,6 independent risk factors including age,obesity,NASH,hepatitis B,type 2 diabetes and family history of PHC were substituted to construct the PHC risk prediction model:ln(p/1-p)=-3.467+1.627 X1 +1.736 X2+1.534 X3+1.505 X4+1.526 X5+1.817 X6 Age(X1),obesity(X2),NASH(X3),hepatitis B(X4),type 2 diabetes(X5),family history of liver cancer(X6).By Hosmer-Lemeshow goodness of fit test,X2=3.947(P>0.05),the model has a good fit.By ROC curve method,the AUC of the PHC risk prediction model training cohort was 0.851(95%CI:0.746-0.893),the specificity was 91.85%,the sensitivity was 63.52%,the positive predictive value was 78.47%,and the negative predictive value was 89.26%.The AUC of the model verification queue is 0.822(95%CI:0.763-0.904),the sensitivity was 58.29%,the specificity was 93.53%,the positive predictive value was 81.82%,and the negative predictive value was 79.41%.The results of De Long test showed that there was no significant difference in the AUC of the PHC risk prediction model between the training cohort and the verification cohort(P>0.05).The model is well differentiated.In addition,the performance of PHC risk prediction line graph in the training cohort(internal verification)and the validation cohort(external verification)was evaluated by drawing calibration curves,which showed that the calibration curve was close to the ideal curve and the model calibration degree was good.ConclusionThe results of this study indicate that obesity is an independent risk factor for PHC,and NASH enhances the strength of the association between obesity and PHC.The PHC risk prediction model based on age,obesity,NASH,hepatitis B,type 2 diabetes and family history of liver cancer further indicated that obesity was an important risk factor for PHC.In addition,the application of PHC risk prediction line graph is helpful for the assessment of PHC risk and the screening of high risk groups,which is of great significance for the formulation of reasonable PHC prevention and treatment programs in the future. |
