原发性肝细胞肝癌微血管浸润分级的危险因素预测

Risk factors for predicting the grade of microvascular invasion in primary hepatocellular carcinoma

目的:肝切除术前预测肝细胞肝癌(HCC)微血管浸润(MVI)的分级有助于患者治疗策略的选择和预后的评估,本文对原发性HCC的MVI分级预测进行研究。方法:对117例经术后病理证实的原发性HCC患者进行回顾性研究,分析患者的基线资料及各项临床指标(性别、年龄、AFP、肝炎和肝硬化有无)、影像特征(肿瘤直径、数量、包膜)、病理(Edmondson分级),将所有病例分为M0(无MVI)、M1(MVI低危组)和M2(MVI高危组)三组。采用单因素秩和检验、logistic回归、ROC曲线进行统计学分析。结果:单因素秩和检验显示不同MVI分级患者的肿瘤直径、包膜的差异有统计学意义(P<0.001),不同MVI分级的病理Edmondson分级差异也有统计学意义(P=0.037),其余因素在不同MVI分级中差异均无统计学意义(P>0.05);进一步有序多分类logistic回归分析显示肿瘤直径(OR=0.195,P<0.001)、包膜(OR=6.772,P<0.001)及Edmondson分级(OR=5.720,P=0.040)为肝癌MVI分级的独立预测因子。预测MVI分级的最佳肿瘤直径临界值为3.9 cm,直径>3.9 cm是MVI 2级的预测因子,其敏感度为92%,特异度为48.9%,曲线下面积(AUC)为0.764(95%CI:0.656~0.872,P<0.001)。结论:肿瘤直径和包膜可作为术前肝癌MVI分级的有效预测指标,其预测效果与术后Edmondson分级相同。预测原发性HCC的MVI级别的最佳肿瘤直径阈值为3.9 cm。

Objective:Predicting the grade of hepatocellular carcinoma(HCC)microvascular infiltration(MVI)prior to hepatectomy is helpful in the selection of therapeutic strategies and prognostic assessment of patients.Therefore,this study aimed to predict the grade of MVI in HCC.Methods:A retrospective study was conducted on 117 patients with HCC which confirmed by postoperative pathology.Baseline data and clinical indicators(gender,age,AFP level,hepatitis or not,liver cirrhosis or not),imaging characteristics(tumor diameter,number,envelop),and pathological data(Edmondson grading)were analyzed.All cases were divided into M0(no MVI),M1(MVI low-risk group),and M2(MVI high-risk group)groups.Statistical analysis was conducted by single factor rank-sum test,logistic regression,and ROC curve.Results:The single-factor rank-sum test showed that the differences in tumor diameter and capsule of patients with different MVI grades were statistically significant(P<0.001),and the Edmondson grade differences were also statistically significant(P=0.037).There were no significant differences among other factors in different MVI grade(P>0.05).Further logistic regression analysis showed that tumor diameter(OR=0.195,P<0.001),capsule(OR=6.772,P<0.001),and Edmondson grade(OR=6.772,P<0.001)were independent predictors of HCC MVI grade(P<0.05).The optimal tumor diameter cutoff value for predicting MVI grade was 3.9cm.Diameter>3.9cm was a predictor of MVI 2.Its sensitivity was 92%,specificity was 48.9%.and the area under the curve(AUC)was 0.764(95%CI was 0.656~0.872,P<0.001).Conclusion:Tumor diameter and capsule can be used as useful predictors of preoperative HCC MVI grade,with the same predictive effect as postoperative Edmondson grading.The optimal threshold of tumor diameter for predicting MVI grade is 3.9cm.