动脉期肿瘤血供特征在评估肿块型肝内胆管细胞癌患者预后中的价值

The value of tumor blood supply characteristics of arterial phase in evaluating the prognosis of patients with intrahepatic mass-forming cholangiocarcinoma

目的探讨肿块型肝内胆管细胞癌(IMCC)动脉期强化特征与患者预后的相关性。方法回顾性分析2004年6月至2019年2月浙江省丽水市中心医院经病理证实为IMCC,且进行了肝脏MRI或CT增强扫描的92例患者。按肝内原发灶的动脉期强化表现分为富动脉血供组(17例)及乏动脉血供组(75例)。观察患者的临床和影像特征。采用t检验和Fisher检验比较组间计量资料和计数资料的差异。组间生存率分析采用Kaplan-Meier分析和对数秩检验,用Cox回归风险模型分析这些变量与死亡风险之间的关系,对P<0.05的各选项再进行Cox回归多因素分析。结果动脉富血供组和乏血供组患者间淋巴结增大、原发灶长径、CA19-9、治疗方式和动脉期异常灌注强化(HPD)差异有统计学意义(P均<0.05),其他临床特征差异无统计学意义(P>0.05)。CA19-9>200 U/ml、有淋巴结增大、动脉期原发灶周围HPD和动脉期乏血供是IMCC手术患者预后的影响因素(P值分别为0.008、0.002、0.049和0.005)。有淋巴结增大及动脉期乏血供是影响IMCC手术患者预后的独立危险因素(P值分别为0.049和0.045)。结论动脉期肿瘤血供特征是IMCC患者独立的预后影响因素。

Objective To investigate the correlation between the enhancement characteristics in arterial phase and the prognosis of patients with massive intrahepatic cholangiocarcinoma(IMCC).Methods The imaging and clinical data of 92 patients with IMCC who were pathologically confirmed and underwent enhanced MRI or CT in Central Hospital of Lishui from June 2004 to February 2019 were retrospectively analyzed.According to the enhancement pattern of the primary lesion in the arterial phase,patients were divided into rich arterial blood supply group(17 cases)and deficient arterial blood supply group(75 cases).The clinical data and imaging features of these patients were studied.Differences between measurement data and count data between the two groups were compared using t test and Fisher test.Kaplan-Meier analysis and log-rank test were used to analyze overall survival.The Cox regression multivariate analysis was used to study the relationship between the variables and the risk of death.Result The enlargement of lymph nodes,long diameter of the primary lesion,CA19-9,treatment and HPD around the primary lesion in arterial phase were statistically different in the two groups(P<0.05),others were no statistical difference.CA19-9>200 U/ml,lymph node enlargement,HPD around the primary lesion in arterial phase and deficient arterial blood supply were independent factors for the prediction of prognosis in IMCC patients with surgery(P values were 0.008,0.002,0.049 and 0.005,respectively).Lymph node enlargement and deficient arterial blood supply were independent risk factors for the prediction of prognosis in IMCC patients with surgery(P values are 0.049 and 0.045,respectively).Conclusion The blood supply characteristics of arterial phase are independent factors for the prognosis of patients with IMCC.