多期CT增强扫描对术后肝细胞癌的复发风险评估

Risk estimation for recnrremle of postoperative hepatocellular carcinoma recurrence by multi-phase computed tomography

目的探究并验证多期CT检查对肝细胞癌(HCC)根治切除术后肿瘤复发的风险。方法纳入2017年3月~2018年10月在我院接受术前CT评估的128例可手术HCC患者的数据。随访数据来自医院病历。截止2019年4月的随访数据用于回顾性分析术前多相CT对可能影响肝癌患者微血管侵犯及根治性切除术后复发的术前临床资料及CT增强影像特征行单因素及多因素分析。结果在随访期间,128例患者中38例(29.7%)术后HCC复发。微血管浸润(MVI)与HCC复发相关(P<0.01)。尽管术后进行了抗病毒治疗和化学药物治疗,但在44例MVI患者中,有22例在手术切除后复发。MVI的存在可以预测术后复发,敏感性为57.9%,特异性为75.6%,准确率为70.3%。在84例无MVI的肿瘤中,单因素分析证实多期相CT的肿瘤切缘等级、肿瘤包膜完整性与HCC复发相关(P<0.05)。单因素分析显示,各组之间在肝包膜浸润、最大肿瘤直径、肿瘤坏死、动脉期增强率、门静脉期增强率、肿瘤周边增强无明显差异(P>0.05)。结论肿瘤边缘不光滑,肿瘤包膜不完整和肿瘤包膜缺失与术后HCC复发相关。根治性切除术后HCC复发可通过CT预测。

Objective To develop and validate a risk estimation of tumor recurrence following curative resection of operable hepatocellular carcinoma(HCC).Methods This study included the data of 128 patients with operable HCC evaluated by(CT)before operation in our hospital from March 1,2017 to October 1,2018.The follow-up data came from hospital medical records.The follow-up data up to April 2019 were used to analyze the preoperative clinical data and CT enhanced imaging features of preoperative multiphase CT,which may affect microvascular invasion and recurrence after radical resection in patients with liver cancer.Results During the follow-up period,38 of 128 patients(29.7%)had a postoperative HCC recurrence.Microvascular invasion(MVI)was associated with HCC recurrence(P<0.001).Despite postoperative antiviral therapy and chemotherapy,22 of 44 patients with MVI experienced recurrence after surgical resection.The presence of MVI was 57.9%of sensitivity,75.6%of specificity and 70.3%of accuratecy in predicting postoperative recurrence.Of 84 tumors without MVI,univariate analysis confirmed that tumor margins,tumor margin grade,and tumor capsule detection on multiphasic CT were associated with HCC recurrence(P<0.05).Univariate analyses showed no difference between groups with respect to hepatic capsular invasion,largest tumor diameter,necrosis,arterial phase enhanced ratio,portovenous phase enhanced ratio,and peritumoral enhancement.Conclusion That tumor margin is not smooth,and tumor capsule is incomplete and tumor capsule loss is associated with postoperative HCC recurrence.The recurrence of HCC after radical resection can be predicted by CT.