【目的】 评估中医证候对结直肠癌肝转移（CRLM）患者经皮穿刺微波消融术（MWA）治疗的影响，并构建基于中医证候分 型的预后多维预测模型。【方法】 收集2012年10月至2023年10月在中山市中医院接受MWA治疗的86例CRLM患者的临床资 料，包含中医证候类型（气血两虚证及脾肾阳虚证）、肿瘤特征及治疗参数等。利用逻辑回归筛选特征变量，构建预后预测 模型，并通过交叉验证评估其预测性能。【结果】（1）86例CRLM患者中，脾肾阳虚证患者31例（36.05%），气血两虚证患者55例 （63.95%）。（2）相比脾肾阳虚证患者，气血两虚证患者MWA后的无进展生存期（PFS）较长，无进展生存率较高，差异均有统 计学意义（P＜0.01），而2组患者的术后疼痛、发热、感染、肝功能损伤、腹腔/胸腔积液等不良反应发生率比较，差异均无 统计学意义（P＞0.05）。（3）多因素Logistic回归分析结果表明，中医证候类型、肝转移瘤最大直径、肝转移时相和原发肿瘤细 胞核增殖抗原-67（Ki-67）表达率等是1年PFS的独立影响因素（P＜0.05或P＜0.01）。（4）该研究所构建的模型在预测PFS方面 表现出较高的准确性，其受试者工作特征（ROC）曲线下面积（AUC）值及95%置信区间（CI）为0.905（0.830 ~ 0.980）。【结论】 中 医证候对CRLM患者MWA治疗的预后预测具有重要影响，其中以气血两虚证患者的预后较好。该研究首次构建了融合中医 证候的CRLM患者MWA治疗的预后多维预测模型，表明中医证候对评估患者病情进展及预测预后有独特的价值。

Objective To evaluate the impact of traditional Chinese medicine （TCM） syndromes on percutaneous microwave ablation （MWA） treatment in patients with colorectal cancer liver metastases （CRLM） and to construct a multidimensional prediction model prognostic based on TCM syndrome classification. Methods Clinical data were collected from 86 CRLM patients who underwent MWA at Zhongshan Hospital of Traditional Chinese Medicine between October 2012 and October 2023. The clinical information covered TCM syndrome types of qiblood deficiency and spleen-kidney yang deficiency，tumor characteristics，and treatment parameters. Logistic regression was used to screen feature variables for constructing the prognostic predication model， and cross validation was performed to evaluate the prognostic predictive performance. Results （1） Among the 86 CRLM patients， 31 （36.05%） had spleen-kidney yang deficiency syndrome， while 55 （63.95%） had qi-blood deficiency syndrome.（2） Compared to the patients with spleen-kidney yang deficiency syndrome，patients with qi-blood deficiency syndrome exhibited significantly long progression-free survival （PFS） and high progressionfree survival rate（P＜0.01），while no significant differences were presented in the incidences of postoperative adverse events such as pain，fever，infection，liver function impairment，or ascites/pleural effusion among the patients with the two syndrome types（P＞0.05）.（3）Multivariate logistic regression analysis revealed that TCM syndrome type，maximum diameter of metastatic liver tumor，timing of liver metastasis，and Ki-67 expression rate of primary tumors were the independent prognostic factors for 1-year PFS （P＜0.05 or P＜0.01）.（4） The constructed model demonstrated high predictive accuracy for PFS， with an area under the receiver operating characteristic（ROC） curve （AUC） of 0.905（95%CI：0.830-0.980）. Conclusion TCM syndromes have significant influence on the prognosis of CRLM patients undergoing MWA， and the patients with qi-blood deficiency syndrome have favorable prognosis. This study pioneers a multidimensional prognostic prediction model integrating TCM syndromes for MWA-treated CRLM patients，highlighting the unique value of TCM syndromes in assessing disease progression and predicting prognosis.

R273.353

广东省医学科学技术研究基金项目（编号：B2022284）；中山市社会公益与基础研究项目（编号：2023B1084）