术前动脉增强分数预测CNLCⅡb期至Ⅲb期肝细胞肝癌栓塞后生存预后的研究

Preoperative Arterial Enhancement Fraction Predicts the Survival Prognosis of Patients with CNLC StageⅡb toⅢb Hepatocellular Carcinoma after Embolization

目的分析术前癌旁肝组织的动脉增强分数(L-AEF)与肿瘤的动脉增强分数(T-AEF)和中国肝癌分期(CNLC)Ⅱb期至Ⅲb期肝细胞肝癌(HCC)栓塞术后无进展生存期(PFS)与总生存期(OS)的相关性。方法回顾性分析92例在昆明医科大学第二附属医院诊断为HCC并接受经肝动脉化疗栓塞术(TACE)治疗的患者。在每例患者第一次栓塞前的增强CT选取出平扫、动脉晚期及门静脉期,在这三期的癌旁肝组织和肿瘤区域测量得到平均CT值并计算得到L-AEF与T-AEF。全部患者随访时间至2022年8月1日。L-AEF与T-AEF联合术前甲胎蛋白(AFP)及CNLC分期,使用Log-rank检验单因素分析和多因素COX比例风险回归模型分析确定PFS与OS的独立预测因素,使用Kaplan-Meier绘制生存曲线。结果92例患者总死亡率为81.5%,全部患者的中位PFS为0.59年,半年、一年、两年、三年的累积无进展生存率分别是53.3%、39.1%、25.0%及17.4%;全部患者的中位OS为1.96年,半年、一年、三年、五年累积生存率分别是91.3%、78.3%、32.6%、20.5%。T-AEF≥0.767、T-AEF<0.767的中位PFS分别为0.43年(0.22~0.94年)、0.90年(0.19~3.12年);CNLCⅡb期至Ⅲb期的中位PFS分别为1.08年(0.44~3.83年)、0.38年(0.20~1.52年)及0.33年(0.13~2.37年)。T-AEF≥0.767和T-AEF<0.767的中位OS分别为1.50年(0.78~2.94年)和2.16年(1.28~4.55年);AFP≥10 ng/ml和AFP≤10 ng/ml的中位OS分别为1.76年(0.89~2.75年)和3.60年(1.88~5.81年);CNLCⅡb期至Ⅲb期的中位OS分别为2.68年(1.45~4.75年)、1.84年(1.05~3.71年)和1.76年(0.45~2.68年)(P均<0.05)。T-AEF和CNLC是PFS的独立预测因素;T-AEF、AFP和CNLC均是OS的独立预测因素。结论T-AEF≥0.767的HCC具有更短的PFS;TAEF≥0.767和AFP≥10 ng/ml的HCC具有更短的OS。随着CNLC的分期逐渐增加,HCC栓塞后越容易进展,患者OS越短。肿瘤的动脉增强分数(AEF)和CNLC能预测HCC栓塞后的PFS。肿瘤的AEF、AFP和CNLC能预测HCC栓塞后的OS。

Objective The correlation between preoperative arterial enhancement fraction of the adjacent liver tissue(LAEF)and arterial enhancement fraction of the tumor(T-AEF)and the progression-free survival(PFS)and overall survival(OS)of CNLC stageⅡb-Ⅲb HCC after embolization were analyzed.Methods Ninety-two patients diagnosed with HCC and treated with TACE at the Second Affiliated Hospital of Kunming Medical University were analyzed retrospectively.Prior to the first TACE,contrast-enhanced CT was performed to select the plain scan,late arterial phase and portal venous phase.All patients were followed up until August 2022.L-AEF and T-AEF combined with alpha fetoprotein(AFP)and China Liver cancer staging(CNLC)were used to determine the independent predictors of PFS and OS by Log-rank test univariate analysis and multivariate COX proportional hazards regression model analysis,and Kaplan-Meier survival curve was used to plot the survival curve.Results The overall mortality rate among the 92 patients was 81.5 percent.The median PFS for all patients was 0.59 years and the cumulative progression-free survival rates at six months,one year,two years and three years were 53.3%,39.1%,25.0%and 17.4%,respectively.The median OS for all patients was 1.96 years,and half-year,one-year,three-year and five-year survival rates were 91.3%,78.3%,32.6%and 20.5%,respectively.The median PFS of T-AEF≥0.767 and T-AEF<0.767 were 0.43(0.22-0.94)years and 0.90(0.19-3.12)years,respectively.The median PFS of CNLCⅡb toⅢb was 1.08(0.44-3.83)years,0.38(0.20-1.52)years and 0.33(0.13-2.37)years,respectively.The median OS of patients with T-AEF≥0.767 and T-AEF<0.767 were 1.50(0.78-2.94)years and 2.16(1.28-4.55)years,respectively.The median OS of AFP≥10ng/ml and AFP≤10 ng/ml were 1.76(0.89-2.75)years and 3.60(1.88-5.81)years,respectively.The median OS of CNLCⅡb toⅢb was 2.68(1.45-4.75)years,1.84(1.05-3.71)years and 1.76(0.45-2.68)years,respectively.T-AEF and CNLC were independent predictors of PFS.T-AEF,AFP,and CNLC were all independent predictors of OS.Conclusion HCC patients with T-AEF≥0.767 has shorter PFS.HCC with T-AEF≥0.767 and AFP≥10 ng/ml has shorter OS.As the phase of CNLC increases,HCC is more likely to progress after embolization and patients have shorter overall survival.Tumor AEF and CNLC are able to predict PFS after HCC embolism.AEF,AFP and CNLC are able to predict OS after HCC embolism.