基于Gd-EOB-DTPA增强MRI结合临床特征对肝细胞癌术后早期复发预测价值的研究

The Value of Gd-EOB-DTPA-Enhanced MRI Combined with Clinical Features.in Predicting Early Recurrence of Hepatocellular Carcinoma After Resection

目的探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强MRI结合临床特征对肝细胞癌(HCC)术后早期复发的预测价值。方法收集我院2016年8月至2021年1月术前行Gd-EOB-DTPA增强MRI检查并经根治性切除术后病理确诊的HCC患者161例,根据随访结果将患者分为早期复发组与非早期复发组。分析患者的临床、实验室、病理学情况及MRI影像学特征并进行统计学分析。结果HCC术后早期复发组73例,非早期复发组88例。二组在年龄、血清AFP、病理卫星结节、MVI、BCLC分期及CNLC分期差异有统计学意义(P均<0.01)。MRI影像学特征中肿瘤最大直径、肿瘤数目、肿瘤边界、门脉癌栓、大血管侵犯、瘤内出血、瘤内坏死、肿瘤包膜、门脉期非边缘性廓清、瘤周强化、HBP瘤周低信号、HBP肿瘤SI/瘤周SI之间差异有统计学意义(P均<0.05)。单因素分析显示,患者年龄、血清AFP、CNLC分期、MVI、病理卫星结节及MRI征象中的肿瘤大小、肿瘤数目、肿瘤边界、瘤内出血、瘤内坏死、肿瘤包膜情况、门脉癌栓、门脉期非边缘性廓清、瘤周强化、HBP肿瘤SI/瘤周SI、HBP瘤周低信号是HCC患者术后早期复发的相关因子。多因素Cox风险回归分析显示只有年龄、AFP值、CNLC分期和MRI影像特征中的肿瘤边界不规则、HBP瘤周低信号及大血管侵犯是HCC患者术后早期复发的独立预测因子。结论GdEOB-DTPA增强MRI结合临床特征对HCC术后早期复发具有预测价值。

ObjectiveTo explore the predictive value of Gd-EOB-DTPA-enhanced MRI combined with clinical features in predicting early recurrence of hepatocellular carcinoma(HCC)after resection.Methods161 patients pathologically confirmed HCC received Gd-EOB-DTPA enhanced MRI before surgery and radical resection were collected from August 2016 to January 2021.The patients were divided into early relapse group and non early relapse group according to the follow-up results.The clinical,laboratory,pathological conditions and MRI imaging characteristics were analyzed and statistically analyzed.ResultsThere were 73 cases in early recurrence group and 88 cases in non early recurrence group.There were significant differences in age,serum AFP,pathological satellite lesions,MVI,BCLC stage and CNLC stage between the two groups(all P<0.01).In MRI imaging characteristics,there were statistically significant differences between the maximum tumor diameter,number of tumors,tumor boundary,portal vein tumor thrombus,invasion of large vessels,intratumoral hemorrhage,intratumoral necrosis,tumor capsule,portal vein phase enhancement,peritumoral enhancement,HBP peritumoral low signal,and HBP tumor sI/peritumoral sI(all P<0.05).Univariate analysis showed that patient age,serum AFP,CNLC stage,MVI,pathological satellite lesions and tumor size in MRI signs,number of tumors,tumor border,intratumoral hemorrhage,intratumoral necrosis,tumor capsule,portal vein tumor thrombus,portal vein phase enhancement,peritumoral enhancement,HBP tumor sI/peritumoral sI,HBP peritumoral low signal were related factors for early recurrence of HCC patients after surgery.Multivariate Cox risk regression analysis showed that only age,AFP value,CNLC staging,tumor boundary,HBP peritumoral low signal and large vessel invasion were independent predictors of early postoperative recurrence of HCC patients.ConclusionGd-EOB-DTPA enhanced MRI combined with clinical features can predict the early recurrence of HCC after operation.