术前CT征象对孤立性肝癌微血管侵犯及术后早期复发的预测分析

Predictive Value of Preoperative CT Signs on Microvascular Invasion and Early Postoperative Recurrence of Solitary Hepatocellular Carcinoma

目的探讨术前CT征象对孤立性肝癌微血管侵犯(MVI)及术后复发早期复发的预测价值。方法对我院2013年7月至2015年7月之间收治的孤立性肝癌患者术前CT资料进行回顾性分析,依据术后病理结果将患者分为MVI阳性组与阴性组,并进行术后随访。对MVI阳性组与阴性组CT征象的差异进行单因素分析,并通过Logistic回归模型分析出术前CT征象对孤立性肝癌微血管侵犯的独立预测因素;以COX风险比例模型对孤立性肝癌术后早期复发(24个月)风险因素进行单因素和多因素分析。结果共计收集到孤立性肝癌78例,其中MVI阳性24例、阴性54例。MVI阳性组与阴性组的单因素分析显示:两组肝硬化背景、肿瘤部位无统计学差异(均P>0.05);而肿瘤直径、包膜类型、肿瘤形态、癌周强化均存在统计学差异(均P<0.05)。多因素分析Logistic回归结果显示:包膜类型(OR=2.997,P=0.013)、肿瘤形态(OR=4.748,P=0.001)、癌周强化(OR=5.797,P=0.015)是孤立性肝癌微血管侵犯的独立危险因素;COX风险比例模型多因素分析结果显示:包膜类型(HR=2.2,P=0.017)、肿瘤形态(HR=1.996,P=0.025)、微血管侵犯(HR=3.709,P=0.023)是预测孤立性肝癌术后早期复发的风险因素。结论术前CT征象对孤立性肝癌微血管侵犯及术后早期复发具有较高的预测价值。

Objective To investigate the predictive value of preoperative CT signs for microvascular invasion(MVI)and early recurrence of isolated hepatocellular carcinoma(HCC).Methods The preoperative CT data of solitary hepatocellular carcinoma treated in our hospital from July 2013 to July 2015 were retrospectively analyzed.According to the postoperative pathological results,the patients were divided into MVI positive group and negative group,and were followed up after operation.The differences of CT signs between MVI positive group and MVI negative group were analyzed by single factor analysis.The independent predictors of preoperative CT signs for microvascular invasion in isolated hepatocellular carcinoma were analyzed by Logistic regression model.The risk factors for early recurrence(24 months)of isolated hepatocellular carcinoma after operation were analyzed by single factor and multiple factor analysis using COX risk distribution model.Results A total of 78 cases of solitary liver cancer were collected,of which 24 were MVI positive and 54 were negative.The univariate analysis of MVI positive group and negative group showed that there was no significant difference in cirrhosis and tumor location between the two groups(P>0.05),but there were significant differences in tumor diameter,capsule type,tumor morphology and Peri-cancer enhancement(P<0.05).Multivariate logistic regression analysis showed that type of capsule(OR=2.997,P=0.013),tumor morphology(OR=4.748,P=0.001)and Peri-cancer enhancement(OR=5.797,P=0.015)were independent risk factors for microvascular invasion in isolated hepatocellular carcinoma.Multivariate analysis of COX proportional hazard model showed that type of capsule(HR=2.2,P=0.017),tumor morphology(HR=1.996,P=0.025)and microvascular invasion(HR=3.709,P=0.023)were risk factors for early recurrence of isolated liver cancer after operation.Conclusion Preoperative CT signs are valuable in predicting microvascular invasion and early postoperative recurrence of solitary hepatocellular carcinoma.