超声造影参数与原发性肝癌患者消融疗效和近期预后的相关性

Correlation between contrast-enhanced ultrasound parameters and ablation efficacy and short-term prognosis in patients with primary liver cancer

目的探究超声造影(CEUS)参数与原发性肝癌(PLC)患者消融疗效和近期预后的关系。方法选取2019年10月至2021年5月在西安国际医学中心医院行超声引导下射频消融术治疗的110例PLC患者开展前瞻性研究。治疗结束后1个月行CEUS检查以评估疗效,比较不同疗效患者CEUS定量参数[达峰时间(TTP)、峰值强度(PI)、增强速率(ER)],采用Spearman相关系数分析CEUS定量参数与PLC患者消融疗效、近期预后的相关性,采用受试者工作特征(ROC)曲线、决策曲线(DCA)分析TTP、PI、ER预测近期预后的价值和临床效用。结果超声引导下射频消融术治疗PLC缓解率为85.45%;完全缓解患者TTP长于部分缓解患者、稳定和进展患者,PI、ER低于部分缓解患者、稳定和进展患者,差异均有统计学意义(P<0.05);经Spearman相关系数分析结果显示,PLC患者消融疗效与TTP呈正相关(r=0.723,P<0.05),与PI、ER呈负相关(r=-0.765、-0.843,P<0.05);PLC患者近期预后与TTP呈正相关(r=0.723,P<0.05),与PI、ER呈负相关(r=-0.765、-0.843,P<0.05);经ROC分析结棍显示,TTP、PI、ER联合预测近期预后为死亡的曲线下面积(AUC)为0.937;采用DCA分析结果显示TTP、PI、ER联合在预测PLC患者消融治疗近期预后方面拥有良好的临床效用。结论CEUS定量参数TTP、PI、ER与PLC患者消融疗效、近期预后密切相关,TTP、PI、ER联合可为临床预测近期预后提供可靠参考依据。

Objective To investigate the relationship between contrast-enhanced ultrasound(CEUS)parameters and ablation efficacy and short-term prognosis in patients with primary liver cancer(PLC).Methods A prospective study was conducted on 110 PLC patients who underwent ultrasound-guided radiofrequency ablation at Xi'an International Medical Center Hospital from October 2019 to May 2021.CEUS examinations were performed one month after the end of treatment to evaluate the efficacy,and the quantitative parameters of CEUS[time to peak(TTP),peak intensity(PI),and enhancement rate(ER)]were compared among patients with different therapeutic effects.Spearman correlation coefficient model was used to analyze the correlation between CEUS quantitative parameters and the ablation efficacy and short-term prognosis of PLC patients.Results The remission rate of PLC treated by ultrasound-guided radiofrequency ablation was 85.45%.The TTP of complete remission patients was significantly greater than that of partial remission patients,stable and progressive patients,while PI and ER were significantly lower,with statistically significant differences(P<0.05).Spearman correlation coefficient model analysis showed that the ablation efficacy of PLC patients was positively correlated with TTP,and negatively correlated with PI and ER(P<0.05).The recent prognosis of PLC patients is positively correlated with TTP(r=0.723,P<0.05),but negatively correlated with PI and ER(r=-0.765,-0.843,P<0.05).According to the analysis of the receiver operating characteristic(ROC)curve,the area under the curve(AUC)of TTP,PI,and ER in combination for predicting short-term prognosis of death was 0.937.Decision curve analysis(DCA)analysis showed that the combination of TTP,PI,and ER has good clinical efficacy in predicting the short-term prognosis of PLC patients undergoing ablation treatment.Conclusion The quantitative parameters of CEUS(TTP,PI,ER)are closely related to the ablation efficacy and short-term prognosis of PLC patients,and the combination of TTP,PI,and ER can provide reliable reference for clinical prediction of short-term prognosis.