肝细胞癌样影像特征病人的危险因素分析

Analysis of risk factors for HCC-like imaging feature of primary liver cancer

目的 研究术前影像学诊断为肝细胞癌(hepatocellular carcinoma, HCC)的病人术后病理诊断为肝内胆管癌(intrahepatic cholangiocarcinoma, ICC)和混合型肝细胞胆管癌(combined hepatocellular-cholangiocarcinoma, cHCC-ICC)的比例及其危险因素。方法 纳入华中科技大学同济医学院附属同济医院和武汉科技大学附属天佑医院两中心2016年1月至2021年12月术前HCC影像学特征的所有病人。采用单因素和多因素logistic回归分析确定HCC样影像特征病人的独立危险因素。结果 共纳入2 402例术前被影像检查诊断为HCC的病人,通过对比术后病理结果发现其中111例(4.6%)病人确诊为ICC(66例)或cHCC-ICC(45例)。经单因素和多因素分析后,女性、甲胎蛋白(AFP)≤400μg/L、糖类抗原(CA)19-9>37 kU/L、病毒感染性肝炎、无肝硬化和轻度肝硬化、低分化、以及肿瘤最大径≤5 cm是HCC样影像特征的独立危险因素。结论 对于具有HCC样影像特征高危因素的人群,提高其术前诊断性是必要的。

Objective To explore the clinical features of patients with hepatocellular carcinoma(HCC)by preoperative imaging examination and examine the proportion and risk factors of ICC or combined hepatocellular-cholangiocarcinoma(cHCC-ICC)patients by postoperative pathology.Methods All patients with preoperative HCC imaging features from Tongji Hospital and Tianyou Hospital between 2016 and 2021 were recruited.Univariate and multivariate Logistic regression analyses were employed for identifying the independent risk factors of HCC-like imaging features.Results A total of 2402 patients with preoperative HCC imaging features were included.There were 111 patients(4.6%)with ICC(n=66)or cHCC-ICC(n=45)confirmed on pathological examination.Univariate and multivariate analyses revealed that females,alpha-fetoprotein(AFP)≤400μg/L,CA19-9>37 kU/L,viral-infected hepatitis,non/mild cirrhosis,low differentiation and nodules with the largest diameter≤5 cm were the independent risk factors of HCC-like imaging patterns.Conclusion It is imperative to improve preoperative diagnostics for patients with high-risk factors of HCC-like imaging patterns.