小肝癌螺旋CT门脉期最大强化率与病理及免疫组化的研究

Small Hepatocellular Carcinoma:Multiple linear Regression Analysis of Correlation of Peak Contrast Enhancement Ratio in Portal Phase on Multiphase Spiral CT with Histopathological and Immunohistochemical Findings

目的:对小肝细胞肝癌(SHCC)的螺旋CT多期扫描肿瘤门脉期强化程度与组织分级、p53、p21、CD34、VEGF表达的相关性进行多因素分析,试图以螺旋CT多期扫描的影像学评价SHCC的生物学特性,为SHCC的治疗和预后判断提供新的依据。方法:手术病理证实SHCC30例,共33个癌结节,术前均进行螺旋CT多期扫描,其中男26例,女4例。术后肿瘤行大体病理及其HE染色、免疫组化染色分析。结果:门脉期最大强化率高的肿瘤,CD34和p53多为高表达,VEGF多为低表达。三者的标准回归系数分别为0.2809,0.6042和-0.2590,其中p53最大,即p53与癌灶门脉期最大强化率的关系最密切;CD34和VEGF与癌灶门脉期最大强化率的相关性类似,但作用方向相反。结论:螺旋CT多期增强扫描可比较全面观察肿瘤,反映SHCC的生物学特性,且无创、快捷、可重复运用。根据SHCC的螺旋CT征象,可间接评价其相关基因的表达,为SHCC的治疗和预后判断提供新的有价值的依据。

Objective:To study the relationship among peak contrast enhancement ratio in portal phase on multiphase spiral CT and grade of cell differentiation,p53,p21,VEGF,CD34 expressions of small hepatocellular carcinoma (SHCC) by using multiple linear regression analysis,to explore the potency of SCT for evaluating biological features of SHCC and to search for new approaches to SHCC treatment and predicting prognosis.Methods:Multiphase spiral CT scans were performed in 30 patients with 33 lesions of SHCC (≤3.0cm in diameter) confirmed histopathologically.Of these patients 26 were male and 4 were female,aged from 34 to 70 (mean 50.1 years old).Immunohistochemical and HE staining were performed in surgical samples of all patients with SHCC.All samples' size was measured and the number of masses in each patient was counted.Results:SHCC with high pCER in portal vein phase always had higher level of CD34 and p53 expression,and lower level of VEGF expression.P53 expression was the most important factor contributing to pCER of SHCC in portal vein phase (R=0.6042),and then CD34 (R=0.2809) and VEGF (R=0.2590).Conclusion:Multiphase spiral CT is an method to comprehensively assess biological behaviors of SHCC in a noninvasive,quick and repeatable way.Genes expression of SHCC can be assessed indirectly,and valuable approaches to SHCC treatment and predicting prognosis can be achieved by SCT features of SHCC.