术前MR影像特征对肝细胞癌手术切除术后早期复发的预测价值

Value of preoperative magnetic resonance imaging features in predicting early recurrence of hepatocellular carcinoma after surgical resection

目的:探究肝细胞癌(hepatocellular carcinoma,HCC)术前临床资料及MR影像特征对HCC手术切除术后早期复发(2年内复发)的预测价值。方法:回顾性分析2015年1月至2018年1月间在天津医科大学肿瘤医院行手术切除术的244例HCC患者资料。对可能影响HCC手术切除术后早期复发的术前临床资料及MR影像特征行单因素、多因素分析。所有患者出院后均规律随访,终点事件为术后2年内肝内复发。结果:单因素分析筛选出肿瘤最大径、肿瘤包膜、瘤周肝实质强化、环形强化、TTPVI、瘤内坏死、卫星灶、动态增强模式、DWI/T2WI不匹配等MR影像特征及甲胎蛋白(alpha-fetoprotein,AFP)、TNM分期、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、谷氨酸氨基转移酶(glutamatergic aminotransferase,AST)、直接胆红素(direct bilirubin,DBIL)、γ-谷氨酰转肽酶(γ-glutamyl transferase,γ-GT)等临床资料为肝癌患者切除术后早期复发的影响因素。将上述变量纳入多因素Cox回归分析:肿瘤包膜(HR=0.372,P<0.05)、环形强化(HR=2.947,P<0.05)、TTPVI(HR=1.993,P=0.004)、卫星灶(HR=2.192,P=0.017)及AFP(HR=2.234,P<0.05)为HCC患者手术切除术后早期复发的独立预测因子。根据多因素Cox回归分析结果绘制诺模图,可直观显示复发风险。结论:肿瘤包膜、环形强化、TTPVI、卫星灶等MR影像特征及AFP>400μg/L为HCC患者术后早期复发的独立预测因子。用非侵袭性方法建立HCC手术切除术后早期复发的预测模型,可以帮助临床医生制定个体化治疗方案,改善患者预后。

Objective: To assess the value of preoperative clinical data and magnetic resonance(MR) imaging features in predicting early recurrence(recurrence in two years) after surgical resection of hepatocellular carcinoma(HCC). Methods: This retrospective study included 244 patients with HCC who underwent a surgical resection between January 2015 and January 2018 at Tianjin Medical University Cancer Institute and Hospital. The role of preoperative clinical data and MR imaging features on early recurrence after surgical tumor resection were evaluated using univariate and multivariate analyses. All patients were followed up regularly after discharge.The endpoint was considered to be intrahepatic recurrence within 2 years. Results: In the univariate analyses, the maximum diameter of the tumor, tumor capsule, peritumoral parenchyma enhancement, rim enhancement, two-trait predictor of venous invasion(TTPVI), tumor necrosis, satellite nodules, dynamic enhancement pattern, diffusion-weighted imaging(DWI)/T2 WI mismatch and other MR imaging features, as well as alpha-fetoprotein(AFP), TNM stage, alanine aminotransferase(ALT), glutamatergic aminotransferase(AST), direct bilirubin(DBIL), γ-glutamyl transferase(γ-GT) and other clinical data were correlated with the early recurrence of HCC. In the multivariate Cox regression analysis, the tumor capsule(HR=0.372, P<0.05), rim enhancement(HR=2.947, P<0.05), TTPVI(HR=1.993, P=0.004), satellite nodules(HR=2.192, P=0.017) and AFP >400 μg/L(HR=2.234, P<0.05) were independent factors of early recurrence after surgical resection of HCC. According to the results of the multivariate Cox regression analysis, a nomogram can be drawn to intuitively show the risk of recurrence. Conclusions: MRI features like tumor capsule, rim enhancement, TTPVI, satellite nodules, and AFP >400 μg/L were found to be independent factors of the early postoperative recurrence of HCC. This research has established a predictive model for the early recurrence of HCC after surgical resection using a non-invasive method, which can help clinicians to develop individualized treatment protocols and improve patient outcomes.