肝细胞癌假包膜的MRI表现预测其生物学特征的临床应用价值

MRI was used to evaluate the pseudoenvelope integrity of hepatocellular carcinoma and to predict its biological characteristics

目的 比较肝细胞癌(HCC)假包膜完整性的MRI表现与其生物学特征[病理分级、门静脉癌栓(PVTT)、术前肝内转移、术后复发、术后肝内转移]之间的关系,从而评估假包膜MRI表现预测HCC临床预后的应用价值。方法 回顾性分析2018年1月~2019年12月经我院手术病理证实HCC病例,且术后随访时间大于半年的53例HCC患者。分析患者术前MRI检查图像,根据有无假包膜及假包膜的完整性分为完整假包膜、部分及无假包膜,并评价HCC假包膜完整性与病理分级、PVTT、术前肝内转移、术后复发、术后肝内转移的相关性差异。结果 53例HCC患者共54个肿瘤病灶。在MRI上具有完整假包膜20例(37.0%)中,合并PVTT 2例(10.0%),术前肝内转移4例(20.0%),术后复发4例(20.0%),术后肝内转移2例(10.0%)。部分及无假包膜为34例(63.0%)中,PVTT 12例(35.3%),术前肝内转移10例(29.4%),术后复发18例(52.9%),术后肝内转移21例(61.8%)。HCC包膜完整性与门静脉有无癌栓、术后复发、术后肝内转移率之间差异具有统计学意义(P<0.05);与术前肝内转移率差异不明显(P>0.05)。根据病理分级,高分化10例,中分化37例,低分化7例。高、中、低三型HCC完整假包膜比率分别为50.0%、35.1%、28.6%,部分及无假包膜病例所占比率分别为50%、64.9%、71.4%,尽管随着肝癌病理分型降低,HCC假包膜的完整率有降低趋势,但三组之间差异不具有统计学意义(P=0.609)。结论 HCC肿瘤假包膜完整性的MRI表现能够在一定程度上评估其临床预后,但尚不能作为判断其病理分级的预测指标。

Objective To investigate the MRI findings of pseudoenvelope integrity in hepatocellular carcinoma(HCC) and to predict the biological characteristics(pathological grade, portal vein embolus, preoperative intrahepatic metastasis, postoperative recurrence, postoperative intrahepatic metastasis) and further evaluate the clinical prognosis. Methods A retrospective analysis was conducted on HCC cases confirmed by surgical pathology in our hospital and examined by dynamic contrast-enhanced MRI scan within 1 month before surgery from January 2018 to December 2019. Fifty-three HCC patients with more than half a year of postoperative follow-up were selected. Preoperative MRI images of the patients were analyzed. According to the presence or absence of pseudocapsule and the integrity of the pseudocapsule, they were divided into complete pseudocapsule, partial and no pseudocapsule. The correlation between HCC capsule integrity and portal vein cancer thrombus, preoperative intrahepatic metastasis, pathological grade, postoperative recurrence, and postoperative intrahepatic metastasis were evaluated. Results Fifty-three patients with HCC had 54 tumor lesions. On MRI images, there were 20 cases(37.0%) with complete capsule, 2 cases(10.0%) with portal vein cancer thrombus, 4 cases(20.0%) with preoperative intrahepatic metastasis, 4 cases(20.0%) with postoperative recurrence, 2 cases(10.0%) with postoperative intrahepatic metastasis. There were 34 cases(63.0%) with partial or no capsule, including 12 cases(35.3%) with portal vein cancer thrombus, 10 cases(29.4%) with preoperative intrahepatic metastasis, 18 cases(52.9%) with postoperative recurrence, 21 cases(61.8%) with postoperative intrahepatic metastasis. There were significant differences between HCC capsule integrity and portal vein thrombus, postoperative recurrence, and postoperative intrahepatic metastasis rate, with statistical significance(P<0.05). There was no significant difference in the preoperative intrahepatic metastasis rate and pathological grade(P>0.05). According to pathological classification, 10 cases were highly differentiated, 37 cases were moderately differentiated, and 7 cases were poorly differentiated. The percentages of high, medium and low HCC cases with false capsule integrity were 50.0%, 35.1% and 28.6%, respectively, and the percentages of partial and no false capsule were 50.0%, 64.9% and 71.4%, respectively. Although the false capsule integrity rate of HCC had a decreasing trend with the decrease of HCC pathological classification, there was no statistically significant difference between the three groups(P=0.609). Conclusion MRI manifestations of capsular integrity of HCC tumor can be used to evaluate the clinical prognosis of HCC to a certain extent, but cannot be used as a predictor of pathological grade.