摘要
目的探究甲胎蛋白及增强MRI影像特征对肝细胞癌微血管侵犯(MVI)的预测价值。方法回顾分析2017年1月至2019年4月在天津医科大学肿瘤医院行肝切除术的206例肝细胞癌患者资料,其中男性179例,女性27例,平均年龄58.7岁。收集患者临床资料和MRI影像资料,单因素和多因素logistic回归分析肝细胞癌MVI影响因素,并绘制列线图。结果术后病理MVI阴性120例,阳性86例。多因素logistic回归分析,甲胎蛋白>400μg/L(OR=3.318,95%CI:1.243~8.855,P=0.017)、瘤内动脉和低信号环征象(TTPVI)(OR=13.111,95%CI:6.797~28.119,P<0.001)、弥散加权成像/T2加权成像(DWI/T2WI)不匹配(OR=17.233,95%CI:4.731~44.490,P<0.001)、环形强化(OR=5.665,95%CI:2.579~18.152,P=0.013)的肝细胞癌患者MVI风险增加。依据上述危险因素构建的列线图可直观显示肝细胞癌MVI风险。结论甲胎蛋白>400μg/L、TTPVI、DWI/T2WI不匹配、环形强化是肝细胞癌患者MVI的独立危险因素,依据多因素分析建立的MVI预测模型有助于临床医生为肝细胞癌患者制定个体化治疗方案。
Objective To study the predictive value of combining alpha-feto protein(AFP)with contrast-enhanced MRI imaging features in predicting incidence of microvascular invasion(MVI)in patients with hepatocellular carcinoma.Methods The data of 206 patients with hepatocellular carcinoma treated at Tianjin Medical University Cancer Institute and Hospital from January 2017 to April 2019 were retrospectively analyzed.There were 179 males and 27 females,with an average age of 58.7 years.The roles of preoperative MRI imaging features and clinical data on predicting the incidence of MVI in patients with hepatocellular carcinoma were evaluated by univariate and multivariate logistic regression analyses.Multivariable regression analysis was then used to plot a nomogram.Results There were 86 patients(41.7%)with MVI positivity and 120 patients(58.3%)with MVI negativity.Multivariate logistic regression analysis showed that AFP>400μg/L(OR=3.318,95%CI:1.243-8.855,P=0.017),two-trait predictor of venous invasion(TTPVI)(OR=13.111,95%CI:6.797-28.119,P<0.001),diffusion weighted imaging/T2 weighted imaging(DWI/T2WI)mismatch(OR=17.233,95%CI:4.731-44.490,P<0.001),and rim enhancement(OR=5.665,95%CI:2.579-18.152,P=0.013)predicted increased risks of MVI in patients with hepatocellular carcinoma.The constructed nomogram directly predicted the risk of MVI in these patients.Conclusions AFP>400μg/L,TTPVI,DWI/T2WI mismatch and rim enhancement were independent risk factors in predicting MVI in patients with hepatocellular carcinoma.This predictive model of MVI which was based on multivariate logistic regression analysis was helpful to clinicians in making individualized treatment plans for patients with hepatocellular carcinoma.
作者
李文萃
韩丽珠
马菊香
叶兆祥
Li Wencui;Han Lizhu;Ma Juxiang;Ye Zhaoxiang(Department of Radiology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第4期266-269,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
磁共振成像
影像特征
微血管侵犯
Carcinoma,hepatocellular
Magnetic resonance imaging
Imaging features
Microvascular invasion