原发性肝细胞癌病理特征对超声造影廓清时间的影响

Relationship between pathological features and wash-out time of primary hepatocellular carcinoma

目的:通过分析原发性肝细胞癌(HCC)分化程度、Ki-67和p53表达以及病灶大小对超声造影(CEUS)廓清时间的影响,探讨CEUS对HCC病理特征的预测价值。方法:回顾性分析经病理证实的229例患者共246个HCC病灶的CEUS廓清时间。按病理分化程度将病灶分为高分化和中低分化两组;按阳性百分比将免疫组化参数Ki-67及p53分为阴性组和阳性组;按最大直径将病灶分为3组:a组(≤3 cm)、b组(>3~5 cm)、c组(>5 cm)。采用χ2检验比较不同分化程度、Ki-67及p53表达和不同直径的HCC超声造影廓清时间的差异。结果:(1)不同分化程度HCC的廓清时间差异有统计学意义(P<0.05),中低分化HCC多在60 s前廓清(46.8%),高分化HCC多在120~300 s廓清(34.8%)。(2)不同Ki-67表达HCC的廓清时间差异总体无统计学意义(P>0.05)。(3)不同p53表达HCC的廓清时间总体差异无统计学意义(P>0.05)。组间两两比较显示,不同p53表达HCC在120~300 s廓清的差异有统计学意义,与阳性组相比,p53阴性组在120~300 s廓清的比例更大(30.2%vs 14.1%)。(4)不同直径HCC的廓清时间差异总体无统计学意义(P>0.05)。与b组和c组相比,a组未廓清的比例更大(a组vs b组vs c组:15.1%vs 5.2%vs 5.3%)。结论:CEUS廓清时间在不同分化程度和不同p53表达的HCC中存在差异,表明CEUS对HCC的病理特征具有一定的预测价值。

Objective:To investigate the predictive value of contrast-enhanced ultrasound(CEUS)for the pathological features of primary hepatocellular carcinoma(HCC),we analyzed the relationship of the wash-out time of CEUS and the pathologi-cal features of HCC,including differentiation degree,expression of Ki-67 and p53,and lesion size.Methods:This study included 246 HCC lesions in 229 patients,which was diagnosed by pathology.The wash-out time of CEUS was analyzed.Ac-cording to the differentiation degree,the lesions were divided into high differentiation and medium-low differentiation groups.According to positive percentage of Ki-67 and p53,the lesions were divided into negative and positive groups.According to the diameter,the lesions were divided into three groups:a(≤3 cm),b(>3~5 cm),and c(>5 cm)groups.Comparisons of the wash-out time in different groups were performed by Chi-square test.Results:(1)There was significant difference in wash-out time of HCC between high differentiation and medium-low differentiation groups(P<0.05).The wash-out time of medium-low differentiation HCC was mostly before 60 s(46.8%),and that of high differentiation HCC was mostly in 120~300 s(34.8%).(2)There was no significant difference in wash-out time of HCC between Ki-67 postive and Ki-67 negative groups(P>0.05).(3)There was no significant difference in wash-out time of HCC between p53 positive and p53 negative groups(P>0.05).Compared to p53 positive group,the percentage of wash-out time in 120~300 s was higher in the p53 negative group(30.2%vs14.1%).(4)There was no significant difference in the wash-out of HCC among different diameters(P>0.05).Compared with b group and c group,a group had a higher proportion of no wash-out(a group vs b group vs c group,15.1%vs 5.2%vs5.3%).Conclusions:There were significant differences in wash-out time of HCC with different differentiation degrees,as well as with different p53 expression,which suggest that CEUS has certain predictive value for the pathological features of HCC.