MRI马赛克结构联合微血管侵犯预测肝细胞癌肝切除术后早期复发的价值

The value of MRI mosaic structure combined with microvascular invasion in predicting early recurrence of hepatocellular carcinoma after hepatectomy

目的探讨基于MRI特征和临床病理特征预测肝细胞癌(HCC)患者肝切除术后早期复发的价值。方法回顾性分析经根治性手术切除的136例单发无大血管侵犯的HCC患者MRI影像特征及临床病理特征,根据病理结果分为早期复发组96例(70.59%)和无早期复发组40例(29.41%)。对2组HCC患者临床病理特征及瘤体MRI特征进行单因素及多因素生存分析,筛选出预测早期复发的独立危险因素。采用受试者工作特征曲线(ROC曲线)评价预测因素评估早期复发的诊断效能。结果早期复发组患者AST水平、中性粒细胞水平高于无早期复发组,2组间差异有统计学意义(P<0.05)。早期复发组患者多发生MVI、瘤体最大直径较大、瘤体形态边缘多不规则、多存在瘤内动脉、多存在瘤体内马赛克结构、瘤体包膜多不完整、强化方式多为靶环样强化,2组间差异有统计学意义(P<0.05)。多因素生存分析结果显示,患者术前MRI存在瘤体内马赛克结构(HR=0.545,95%CI:0.301~0.988,P<0.05)和术后存在MVI(HR=0.395,95%CI:0.206~0.757,P<0.05)是单发无大血管侵犯的HCC患者肝切除术后早期复发的独立危险因素。联合2个预测因素评估HCC患者早期复发的AUC为0.789(95%CI:0.706~0.872),灵敏度为65.62%,特异度为82.50%。结论MRI瘤体内马赛克结构和MVI是单发无大血管侵犯的HCC患者早期复发的独立危险因素,对于评估HCC患者术后复发风险具有一定临床价值。

Objective To investigate the predictive values of MRI features and clinicopathological features on early recurrence after hepatectomy in hepatocellular carcinoma(HCC).Methods A total of 136 patients with single HCC without macrovascular invasion who underwent partial hepatectomy were retrospectively analyzed.According to the pathological results,they were divided into early recurrence groups(n=96,70.59%)and non-early recurrences groups(n=40,29.41%).Patients′preoperative imaging features and clinicopathological data were analyzed by univariate and multivariate analysis,then the independent predictors of early recurrence were explored.ROC curve analysis was performed to evaluate the efficacy of clinical features and tumor MRI radiologic features to diagnose early recurrence.Results The levels of AST and neutrophils in the early recurrence group were higher than those in the non-early recurrence group(P<0.05).In the early recurrence group,most of the patients had MVI,larger maximum diameter of the tumor,more irregular edge of the tumor shape,more intratumoral arteries,more mosaic structure in the tumor,more incomplete tumor capsule,and target ring-like enhancement in the enhancement pattern,and the differences between the two groups were statistically significant(P<0.05).Multivariate logistic regression analysis showed mosaic structure and MVI were independent predictors of early recurrence in HCC.The area under the ROC curve of the combined two indicators for predicting early recurrence in HCC was 0.789,and the sensitivity and specificity were 65.62%and 82.50%,respectively.Conclusion The MRI mosaic structure and MVI are independent risk factors for early recurrence in single HCC without macrovascular invasion and it has great clinical value for preoperative assessment of early recurrence.