LI-RADS类别与肝细胞癌肿瘤分化程度、Ki67指数、微血管侵犯的相关性分析及其对患者预后的预测价值

To study the correlation between LI-RADS category with tumor differentiation,Ki67 index,microvascular infiltration,and prognosis in HCC

目的探讨肝脏影像报告和数据系统(LI-RADS)类别与肝细胞癌肿瘤分化程度、Ki67指数、微血管侵犯的相关性以及其对患者预后的预测价值。方法回顾性分析2015年1月至2020年9月丽水市中心医院和丽水市人民医院收治的经手术病理证实为肝细胞癌的178例患者的临床及影像资料。178例肝细胞癌患者中,男性156例,女性22例,年龄(57±10)岁。178例患者依照2018版LI-RADS评估LI-RADS类别,按照评估结果分为4组:归为LI-RADS-3者12例(LI-RADS-3组);LI-RADS-4者26例(LI-RADS-4组);LI-RADS-5者102例(LI-RADS-5组);LI-RADS-M者38例(LI-RADS-M组)。记录患者的一般资料、肿瘤标志物、病理等临床资料。LI-RADS类别与病理的相关性分析采用Kendall's tau-b检验;组间生存率分析采用Kaplan-Meier分析和对数秩检验,Cox回归风险模型分析这些变量与死亡风险之间的关系。结果Kendall's tau-b检验显示,LI-RADS类别与肿瘤分化程度呈正相关(t=0.204,P=0.002),但与微血管侵犯和Ki 67指数无相关性(P>0.05)。所有患者均获得随访,随访4.2~84.2个月,中位随访时间36.3个月。截至随访结束,死亡患者31例,存活147例。LI-RADS-5组1、3年累积生存率分别为97%和90%,高于LI-RADS-M组的81%和63%,以及LI-RADS-4组的96%和81%,差异均具有统计学意义(P<0.05);LI-RADS-3组1、3年累积生存率分别为100%和67%,与LI-RADS-5组差异无统计学意义(P>0.05)。Cox多因素回归分析显示,肿瘤糖类抗原199>50μl/ml是决定患者生存时间的独立影响因素(HR=0.43,95%CI:0.24~0.76,P=0.004)。结论肝细胞癌的LI-RADS类别与肿瘤分化程度呈正相关性,符合LI-RADS-5标准的肝细胞癌患者预后相对较好。

ObjectiveTo study the correlation between liver imaging reporting and data system(LI-RADS)category with tumor differentiation,Ki67 index,microvascular infiltration,and predictive prognosis in hepatocellular carcinoma(HCC).MethodsWe retrospectively analyzed the clinical and radiological data of 178 patients with HCC who were confirmed by histopathological studies after liver resection between January 2015 and September 2020 at Lishui Central Hospital and Lishui People’s Hospital.There were 156 males and 22 females,with age of(57±10)years old.These patients were assessed for LI-RADS categories according to the 2018 version of LI-RADS,and they were divided into 4 groups according to the assessment results:12 patients with LI-RADS-3(the LI-RADS-3 group);26 patients with LI-RADS-4(the LI-RADS-4 group);102 patients with LI-RADS-5(the LI-RADS-5 group);and 38 patients with LI-RADS-M(the LI-RADS-M group).The patients'general information,tumor markers,pathology and other clinical data were recorded.Correlation analysis between the LI-RADS category with pathology was performed by the Kendall's tau-b test.Survival analysis between groups was performed by the Kaplan-Meier analysis.The Cox regression risk model was used to analyze the relationship between these variables with the risk of death.ResultsThe Kendall's tau-b test showed that LI-RADS category was positively correlated with the degree of tumor differentiation(t=0.204,P=0.002),but not with microvascular infiltration and Ki 67 index(P>0.05).All patients were followed up for 4.2 to 84.2 months(median follow-up 36.3 months).By the end of follow-up,31 patients had died and 147 patients were alive.The cumulative 1-year and 3-year survival rates of the LI-RADS-5 group were 97%and 90%respectively,which were significantly higher than those in the LI-RADS-M group(81%and 63%),and the LI-RADS-4 group(96%and 81%),(P<0.05).The cumulative 1-year and 3-year survival rates of patients in the LI-RADS-3 group were 100%and 67%respectively,and there was no statistically significant difference with the LI-RADS-5 group(P>0.05).The Cox multivariate regression analysis showed that tumor glycoantigen 199(>50μl/ml)to be an independent influencing factor in survival of HCC patients(HR=0.43,95%CI:0.24-0.76,P=0.004).ConclusionThe LI-RADS category of HCC was positively correlated with the degree of tumor differentiation,and patients with HCC meeting the LI-RADS-5 criteria had relatively better prognosis.