术前超声检查对肝癌切除术后早期复发因素的预测价值

Predictive value of preoperative ultrasound examination for factors associated with early postoperative recurrence of hepatocellular carcinoma after surgical resection

目的研究肝细胞癌（HCC）患者肝切除术后早期复发相关的危险因素,着重探讨术前超声检查在预测肝癌切除术后早期复发中的价值。方法回顾性分析2010年12月-2014年1月于中南大学湘雅医院接受肝癌切除术的患者59例,根据术后1年内有无复发将患者分为早期复发组（27例）和早期未复发组（32例）。整理术前接受超声造影检查的HBV相关HCC患者的人口统计学资料、实验室检查资料、常规超声及超声造影诊断资料,分析其对早期复发的预测价值。计量资料采用t检验或Mann-Whitney U检验,计数资料采用χ~2检验或Fisher’s检验,多因素分析采用Logistic回归分析。结果单因素分析显示两组患者术前血清AFP≥400 ng/ml、肿瘤最大直径≥5 cm、有大血管侵犯、超声造影显示＂快出＂增强模式、造影剂显示非均匀分布特征是HCC切除术后早期复发的危险因素（P值均〈0.05）;多因素分析显示术前血清AFP≥400 ng/ml[比值比（OR）=14.90,95%可信区间（95%CI）：1.44~154.39,P=0.02]、肿瘤最大直径≥5 cm（OR=6.75,95%CI：1.07~42.50,P=0.04）、超声造影＂快出＂增强模式（OR=9.67,95%CI：1.78~52.54,P=0.01）是HCC切除术后早期复发的独立危险因素。通过对各独立危险因素及其组合预测早期复发的敏感性评估发现,超声造影＂快出＂增强模式与肿瘤最大直径≥5 cm的敏感性差异无统计学意义（P〉0.05）,而与其他指标的敏感性差异均有统计学意义（P值均〈0.05）,且均高于其他指标。结论以超声造影＂快出＂增强模式预测HCC早期复发的敏感性较高,有可能作为复发高危人群筛查的有效指标之一,并为HCC围手术期及术后长远的肿瘤综合治疗方案的制订和完善提供有利的指导意见。

Objective To investigate the risk factors associated with early postoperative recurrence of hepatocellular carcinoma（ HCC） after surgical resection,and to discuss the predictive value of preoperative ultrasound examination for early recurrence of HCC after surgical resection. Methods The clinical data of 59 patients who underwent radical resection for HCC in Xiangya Hospital of Central South University from December 2010 to January 2014 were analyzed retrospectively. These patients were divided into early recurrence group（ 27 patients）and no early recurrence group（ 32 patients） based on whether recurrence occurred within 1 year after resection. The demographic data,laboratory examination data,and diagnostic data for conventional ultrasound and contrast- enhanced ultrasound（ CEUS） in HCC patients with HBV who received CEUS before surgery were analyzed to determine their predictive values for early recurrence of HCC. The t- test or Mann-Whitney U test was applied for continuous data,chi- square test or Fisher＇s exact test was applied for categorical data,and the logistic regression model was applied for multivariate analysis. Results Univariate analysis showed that preoperative serum α- fetoprotein（ AFP）level ≥400 ng / ml,maximum tumor diameter ≥5 cm,involvement of major blood vessels,a ＂ fast wash- out＂ enhancement pattern on CEUS,and uneven distribution of contrast agent were risk factors for early postoperative recurrence（ all P〈0. 05）. Multivariate analysis showed that preoperative serum AFP level ≥400 ng / ml（ OR = 14. 90,95% CI： 1. 44- 154. 39; P = 0. 02）,maximum tumor diameter ≥5 cm（ OR = 6. 75,95% CI： 1. 07- 42. 50; P = 0. 04）,and a ＂fast wash- out＂enhancement pattern on CEUS（ OR = 9. 67,95% CI：1. 78- 52. 54; P = 0. 01） were independent risk factors for early postoperative recurrence. The evaluation of sensitivity of each independent risk factor and their combinations to predict early recurrence showed that the sensitivity of a＂fast wash- out＂enhancement pattern on CEUS did not differ significantly from that of maximum tumor diameter ≥5 cm（ P〉0. 05）,but it was significantly higher than that of the other indicators（ all P〈0. 05）. Conclusion The ＂fast wash- out＂enhancement pattern on CEUS is highly sensitive in predicting early recurrence of HCC; therefore,it can be applied as one effective indicator for high- risk population screening,and provide guidance for the development and perfection of perioperative and postoperative long- term comprehensive therapeutic regimens for HCC.