MRI联合血清miR-204水平对原发性肝癌经皮穿刺射频消融术后疗效及复发的预测价值

The predictive value of MRI combined with serum miR-204 level for the efficacy and recurrence of primary liver cancer after percutaneous radiofrequency ablation

目的:探讨MRI联合血清微小RNA(micro RNA,miR)-204水平对原发性肝癌射频消融(RFA)术后疗效及复发的预测价值。方法:选择2019年8月至2020年8月于本院行RFA治疗的原发性肝癌患者作为研究对象。于RFA术前一周内对研究对象行MRI检查,记录表观扩散系数(ADC)值;采用定量实时聚合酶联反应法测定血清中miR-204的相对表达量;于RFA术后1个月再次进行MRI检查以判断病灶消融情况。对完全消融的患者定期随访1年,记录患者复发情况。结果:经RFA治疗后,完全消融患者182例(85.8%,完全消融组),残留30例(14.2%,残留组),两组患者的性别、年龄、Child-Pugh分级、RFA前AFP水平及合并疾病情况比较差异均无统计学意义(P值均>0.05)。完全消融组的ADC值为(1.30±0.12)×10^(-3) mm^(2)/s,残留组为(1.14±0.12)×10^(-3) mm^(2)/s,两组差异有统计学意义(t=7.091,P<0.001);完全消融组的血清miR-204相对表达量为(1.42±0.12),残留组为(1.25±0.10),两组差异有统计学意义(t=7.246,P<0.001)。ADC值、血清miR-204、ADC值联合血清miR-204预测RFA术后肿瘤残留的曲线下面积(AUC)分别为0.837(95%CI:0.750~0.923)、0.860(95%CI:0.805~0.916)和0.915(95%CI:0.861~0.970)。对RFA治疗后完全消融的182例肝癌患者进行随访,期间11例患者失访,将其剔除,最终32例患者复发(复发组),复发率为18.7%,139例患者未复发(未复发组),复发组的术前ADC值为(1.21±0.14)×10^(-3) mm^(2)/s,显著低于未复发组[(1.33±0.13)×10^(-3) mm^(2)/s,t=5.052,P<0.001];复发组的血清miR-204相对表达量为(1.29±0.12),显著低于未复发组[(1.46±0.14),t=6.188,P<0.001]。ADC值、血清miR-204、ADC值联合血清miR-204预测肿瘤复发的AUC分别为0.742(95%CI:0.646~0.838)、0.822(95%CI:0.746~0.898)和0.868(95%CI:0.807~0.929)。结论:MRI联合血清miR-204对原发性肝癌RFA术后疗效及复发情况具有一定预测价值,可为临床治疗决策的选择提供参考依据。

Objective:To investigate the predictive value of magnetic resonance imaging(MRI)combined with serum micro RNA(miR)-204 level for the efficacy and recurrence of primary liver cancer after percutaneous radiofrequency ablation(RFA).Methods:Patients with primary liver cancer who received RFA treatment in our hospital from August 2019 to August 2020 were selected as subjects.The Siemens Skyra 3.0T MR scanner was used to examine the subjects one week before RFA,and the apparent dispersion coefficient(ADC)was recorded and analyzed.Quantitative real-time polymerase linked reaction was used to determine the relative expression of miR-204 in serum.MRI was performed again one month after RFA to determine whether the lesion was ablated completely.Patients with complete ablation were followed up periodically for 1 years to record their recurrence status.Results:After RFA treatment,182(85.8%)patients were completely ablated,and 30(14.2%)patients remained after RFA treatment.There were no significant differences in gender,age,child-pugh grade,AFP before RFA,and associated diseases between the two groups(P>0.05).ADC in the complete ablation group was(1.30±0.12)×10^(-3) mm^(2)/s,which was significantly higher than that in the residual group(1.14±0.12)×10^(-3) mm^(2)/s(t=7.091,P<0.001).The relative expression level of serum miR-204 in the complete ablation group was(1.42±0.12),which was significantly higher than that in the residual group(1.25±0.10)(t=7.246,P<0.001).The AUC predicted by ADC,serum miR-204 and ADC combined serum miR-204 after RFA were 0.837(95%CI:0.750~0.923),0.860(95%CI:0.805~0.916)and 0.915(95%CI:0.861~0.970).The preoperative ADC of the recurrence group was(1.21±0.14)×10^(-3) mm^(2)/s,significantly lower than that of the non-recurrence group(1.33±0.13)×10^(-3) mm^(2)/s(T=5.052,P<0.001).The relative expression level of serum miR-204 in the recurrence group was(1.29±0.12),which was significantly lower than that in the non-recurrence group(1.46±0.14)(t=6.188,P<0.001).The AUC predicted by ADC,serum miR-204 and ADC combined serum miR-204 after RFA were 0.742(95%CI:0.646~0.838),0.822(95%CI:0.746~0.898)and 0.868(95%CI:0.807~0.929).Conclusion:MRI combined with serum miR-204 has certain predictive value for RFA postoperative efficacy and recurrence of primary liver cancer,which can provide reference for clinical application.