CT量化碘油摄取预测原发性肝癌TACE术后肿瘤复发的临床价值

Clinical Value of CT Quantification of Lipiodol Uptake for Predicting Tumor Recurrence after HCC TACE

目的探讨CT量化碘油摄取预测原发性肝癌经导管肝动脉化疗栓塞(TACE)术后肿瘤复发的临床价值。方法回顾性分析首次行TACE的原发性肝癌患者49例的资料,术后一周行CT扫描,将肿瘤最大层面作为感兴趣区(ROI),观察病灶内碘油摄取形态及基准CT值。患者定期随访,使用改良实体肿瘤疗效评价标准(mRECIST)将患者分为复发组与无复发组,观察各组随访碘油CT值及碘油代谢率,使用SPSS 19.0统计软件,分析对比各组数据,用COX风险回归分析碘油摄取和其他因素对肿瘤复发危险性影响。用受试者工作特征(ROC)曲线确定碘油摄取值预测肿瘤复发的能力。结果随访时间2~6个月,16例(32.7%)病灶复发。碘油摄取形态呈Ⅰ~Ⅳ型,在随访无复发组及复发组中曲线类型分布差异有统计学意义,以Ⅲ、Ⅳ型作为肿瘤复发的判定标准,则诊断肿瘤复发的灵敏度为91.4%,特异度88.6%。肿瘤无复发组碘油摄取基准值、碘油摄取随访值、碘油代谢率分别为(448.6±168.5)HU、(367.1±170.2)HU、(75.4±35.8)HU/月,肿瘤复发组分别为(226.4±196.4)HU、(180.6±153.5)HU,(104.1±56.2)HU/月各组间差异均有统计学意义。在COX多变量模型中,低基准碘油摄取和高的碘油清除率是肿瘤复发的显著预测因子。在ROC分析中,将碘油摄取基准CT值判定肿瘤复发的最佳截断点阈值设为290.5 HU,其灵敏度,特异度分别为91.6%,82.7%。结论CT量化碘油摄取可预测原发性肝癌TACE术后的肿瘤复发,对于决定TACE术后治疗策略有较好的临床实用价值。

Objective To explore the value of CT quantification of lipiodol uptake for predicting tumor recurrence in hepatocellular carcinoma(HCC)after transarterial chemoembolization(TACE).Methods A total of 49 patients with primary hepatocellular carcinoma(HCC)who underwent TACE for the first time were retrospectively analyzed.CT scan was performed one week after surgery,and the largest layer of tumor was used as the ROI of the region of interest.The morphology and baseline CT value of iodized oil intake in the lesion were observed(HU).Patients were followed up regularly,using mRECIST criteria.The patients were divided into relapse group and non-relapse group.Observation was made of the CT value of lipiodol and the metabolic rate of lipiodol in each group.SPSS 19.0 statistical software was used to analyze and compare the data of each group.Risk regression analysis of the effect of iodized oil uptake and other factors determining the risk of tumor recurrence,was done.The receiver operating characteristic(ROC)curve was used to determine the ability of lipiodol uptake to predict tumor recurrence.Results The follow-up period was 2-6 months,and 16 patients(32.7%)had relapsed.The form of lipiodol uptake was typeⅠ~Ⅳ.The distribution of curve types in the follow-up non-recurrence group and recurrence group was statistically significant.Taking typeⅢandⅣas the criterion for tumor recurrence,the sensitivity for diagnosis of tumor recurrence was 91.4%.The specificity was 88.6%.The baseline value of lipiodol uptake,follow-up value of lipiodol uptake and metabolic rate of lipiodol were:(448.6±168.5)HU,(367.1±170.2)HU,(75.4±35.8)HU,and in the tumor recurrence group were(226.4±196.4)HU,(180.6±153.5)HU,104.1±56.2.The differences between the groups were statistically significant.In the COX multivariable model,low baseline iodized oil uptake and high iodized oil clearance are significant predictors of tumor recurrence.In the ROC analysis,the optimal cutoff point threshold for determining tumor recurrence based on the baseline CT value of lipiodol uptake was set at 290.5 HU,and its sensitivity and specificity were:91.6%and 82.7%,respectively.Conclusion CT Quantification of lipiodol uptake is very helpful in providing additional predictive information concerning HHC progression.Therefore,it can yield useful and clinically relevant information for determining subsequent treatment strategies after TACE.