超声造影参数与肝癌微血管侵犯发生的相关性及预后预测价值

Correlation and prognostic predictive value of ultrasonographic parameters with the occurrence of microvascular invasion in hepatocellular carcinoma

目的探讨超声造影参数与肝癌微血管侵犯发生的相关性及预后预测价值。方法回顾性选取2020年1月至2023年1月在宝鸡市中心医院经病理诊断确诊为肝癌的80例患者,依照患者是否发生微血管侵犯进行分组:微血管侵犯组(n=45)、非微血管侵犯组(n=35)。另选取宝鸡市中心医院同期收治的良性肝细胞瘤的40例患者分为对照组。对所有患者进行超声造影诊断,对比其相关参数差异。并采用Spearman相关分析法分析超声造影参数与肝癌微血管侵犯发生的相关性,建立受试者操作特征(ROC)曲线分析超声造影参数对肝癌微血管侵犯的诊断效能。随后对80例肝癌患者进行随访,发生新的转移灶、复发灶及死亡可认定为预后不良,根据预后情况分为预后良好组(n=50)和预后不良组(n=30)。以预后情况作为因变量采用Logistics回归模型分析肝癌预后独立影响因素。结果微血管侵犯组、非微血管侵犯组及对照组患者的达峰强度、始增强度比较,差异无统计学意义(P>0.05);微血管侵犯组达峰时间、始增时间分别为(20.67±3.24)、(9.85±2.63)s,均明显短于非微血管侵犯组[(26.25±5.16)、(11.89±3.13)s]与对照组(35.96±4.16)、(15.57±3.78)s,非微血管侵犯组达峰时间、始增时间短于对照组,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示:达峰强度、始增强度与肝癌微血管侵犯发生无明显相关性(P>0.05),达峰时间、始增时间与肝癌微血管侵犯发生呈正相关(P<0.05)。始增时间对肝癌微血管侵犯的诊断曲线下面积为0.622,敏感度、特异度为61.00%、53.00%,达峰时间对肝癌微血管侵犯的诊断曲线下面积为0.675,敏感度、特异度为65.00%、57.00%,超声造影参数联合对肝癌微血管侵犯的诊断敏感度与特异度明显高于单一指标(P<0.05)。预后良好组与预后不良组患者的TNM分期、肿瘤大小、达峰时间、始增时间比较,差异均有统计学意义(P<0.05)。多因素Logistics回归分析结果显示,TNM分期增加、达峰时间降低、始增时间降低为肝癌预后不良的独立影响因素(P<0.05)。结论超声造影参数与肝癌微血管侵犯发生具有密切相关性,且通过超声造影诊断肝癌微血管侵犯敏感度、特异度较高,同时可通过达峰时间、始增时间对肝癌预后情况进行早期预测。

Objective To explore the correlation and prognostic predictive value of ultrasonographic parameters with the occurrence of microvascular invasion in hepatocellular carcinoma.Methods Eighty patients who were diagnosed as hepatocellular carcinoma by pathology in Baoji Central Hospital from January 2020 to January 2023 were retrospectively selected and grouped according to whether microvascular invasion occurred or not.They were divided into the microvascular invasion group(n=45),and the non-microvascular invasion group(n=35),and 40 patients who were diagnosed as benign hepatocellular tumors at the same period from Baoji Central Hospital were selected as the control group.Perform contrast-enhanced ultrasound diagnosis on all patients and the differences in related parameters were compared.And Spearman correlation analysis was used to analyze the correlation between ultrasound contrast parameters and the occurrence of microvascular invasion in liver cancer,and a receiver operating characteristic(ROC)curve was established to analyze the diagnostic efficacy of ultrasound contrast parameters for microvascular invasion in liver cancer.Subsequently,80 liver cancer patients were followed up.The occurrence of new metastases,relapses,and death can be considered as poor prognosis,according to the prognosis,they were divided into the good prognosis group(n=50)and the poor prognosis group(n=30).With the prognosis as the dependent variable,the independent influencing factors of liver cancer prognosis were analyzed by Logistics regression model.Results There was no significant difference in peak intensity and initial enhancement among the microvascular invasion group,the non-microvascular invasion group and the control group(P>0.05).The peak time and initial increase time in the microvascular invasion group were(20.67±3.24)and(9.85±2.63)s,respectively,which were significantly shorter than those in the non-microvascular invasion group[(26.25±5.16)and(11.89±3.13)s]and the control group[(35.96±4.16)and(15.57±3.78)s],the peak time and initial increase time in the non-microvascular invasion group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The Spearman correlation analysis results showed that there was no statistically significant correlation between the peak intensity and initial increase intensity and the occurrence of microvascular invasion in liver cancer(P>0.05),while the peak time and initial increase time were positively correlated with the occurrence of microvascular invasion in liver cancer(P<0.05).The area under the diagnostic curve for microvascular invasion of liver cancer at the onset time was 0.622,with sensitivity and specificity of 61.00%and 53.00%.The area under the diagnostic curve for microvascular invasion of liver cancer at the peak time was 0.675,with sensitivity and specificity of 65.00%and 57.00%.The diagnostic sensitivity and specificity of the combination of ultrasound contrast parameters for microvascular invasion of liver cancer were significantly higher than those of a single indicator(P<0.05).There were statistically significant differences in clinical stage,tumor size,peak time and initial increase time between the good prognosis group and the poor prognosis group(P<0.05).The results of multivariate Logistics regression analysis showed that the increase of clinical stage,the decrease of peak time and the decrease of initial increase time were independent influencing factors of poor prognosis of liver cancer(P<0.05).Conclusion There is a close correlation between the parameters of contrast-enhanced ultrasound and the occurrence of microvascular invasion in liver cancer,and the sensitivity and specificity of diagnosing microvascular invasion in liver cancer through contrast-enhanced ultrasound are high.At the same time,the prognosis of liver cancer can be predicted early by the peak time and onset time.