MRI动脉期强化模式对肝内胆管细胞癌术后早期复发预测价值

Intrahepatic mass-forming cholangiocarcinoma:relationship between arterial phase enhancement at MRI and early recurrence

目的:探讨MR动脉期强化模式对肝内胆管细胞癌(IMCC)术后早期复发的价值,并基于MR及临床病理资料建立预测IMCC术后早期复发的列线图。方法:对本院2013年1月-2018年6月间收治的IMCC患者的临床病理及MR资料回顾性分析,据术后1年随访结局将患者分为复发组与无复发组。单因素分析各因素对IMCC术后早期复发的相关性并进一步行Logistic回归多因素分析,最后建立预测IMCC术后早期复发的列线图预测模型。结果:入组92例IMCC患者中复发组30例、无复发组62例。单因素分析显示动脉期强化模式、T分期、N分期、分化程度、脉管侵犯以及瘤内坏死与IMCC术后早期复发有关(P<0.05)。多因素分析显示动脉期强化模式(OR=4.39,95%CI:1.04~18.62,P=0.045),T分期(OR=5.73,95%CI:1.28~25.77,P=0.023),分化程度(OR=0.021,95%CI:0.05~0.89,P=0.034)、脉管侵犯(OR=4.74, 95%CI:1.13~19.87,P=0.034)、瘤内坏死(OR=7.15,95%CI:1.27~40.26,P=0.026)是预测IMCC术后早期复发的独立危险因素。基于多因素分析建立的列线图(Model-whole)对各危险因素赋分结果显示动脉期强化模式(弥漫高强化,0分;环形强化,35分;弥漫低强化,100分)、T分期(T1-2,0分;T3-4,72分)、分化程度(低分化,61分;中高分化,0分)、坏死(不存在,0分;存在,70分);该预测模型的C-index为0.911(95%CI:0.876~0.947)。在不纳入动脉期强化模式建立Model-part时该模型的C-index降低为0.878(95%CI:0.839~0.918);此外,决策曲线分析显示Model-whole与Model-part比较体现出更高的净获益。结论:本研究建立了预测IMCC术后早期复发的列线图模型,MR动脉期强化模式对该模型的预测性能存在较大贡献。

Objective:To investigate relationship between arterial phase enhancement at MRI and early recurrence(IMCC),and further to establish a nomogram for predicting the early recurrence of IMCC.Methods:The clinicopathological characteristics and MR finding of IMCC patients from January 2013 to June 2018 in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed.According to the 1-year follow-up results,the patients were divided into recurrence group and recurrence-free group.Those above factors were conducted for Logistic regression analysis,and nomogram was established on this basis.Results:Among 92 patients with IMCC,there were 30 cases in recurrence group and 62 cases in recurrence-free group.Univariate analysis showed that arterial phase enhancement,T stage,N stage,differentiation grade,vascular invasion and intratumoral necrosis were associated with early recurrence after IMCC(P<0.05).Multivariate analysis showed:arterial phase enhancement(OR=4.39,95%CI:1.04~18.62,P=0.045),T stage(OR=5.73,95%CI:1.28~25.77,P=0.023),differentiation grade(OR=0.021,95%CI:0.05~0.89,P=0.034),vascular invasion(OR=4.74,95%CI:1.13~19.87,P=0.034),and intratumoral necrosis(OR=7.15,95%CI:1.27~40.26,P=0.026)were independent risk factors for postoperative early recurrence.The nomogram prediction model(Model-whole)based on multivariate analysis showed that arterial phase enhancement(diffuse hyperenhancement,0 points;peripheral rim enhancement,35 points;diffuse hypoenhancement,100 points),T stage(T1-2,0 points;T3-4,72 points),differentiation grade(poor differentiation,61 points;well,moderate differentiation,0 points),necrosis(absence,0 points;presence,70 points).The c-index of the model was 0.911(95%CI:0.876~0.947).When model part was established without arterial phase enhancement model,the c-index of the model was reduced to 0.878(95%CI:0.839~0.918).In addition,the decision curve analysis shows that Model-whole has higher net benefit than Model-part.