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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (3): 89-95.doi: 10.6040/j.issn.1671-7554.0.2021.1046

• • 上一篇    

术前MRI在预测169例肝细胞肝癌微血管侵犯及早期复发的价值

左立平1,2,蒋丰洋1,2,周斌彬1,2,范金蕾1,2,梁永锋2,邓展昊1,2,于德新1,2   

  • 发布日期:2022-03-09
  • 通讯作者: 于德新. E-mail:yudexin0330@sina.com

Value of preoperative multiphase MRI for predicting microvascular invasion and early recurrence of 169 hepatocellular carcinoma

ZUO Liping1,2, JIANG Fengyang1,2, ZHOU Binbin1,2, FAN Jinlei1,2, LIANG Yongfeng2, DENG Zhanhao1,2, YU Dexin1,2   

  1. 1. Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2022-03-09

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摘要： 目的 探讨术前增强磁共振成像(MRI)在预测肝细胞肝癌(HCC)微血管侵犯及其在早期复发中的价值。 方法 回顾性分析2015年1月至2019年1月接受手术治疗并行术前增强MRI HCC患者169例。并对可能与微血管侵犯和早期复发(≤2年)相关的临床、实验室和影像学特征进行评估分析。单元和多元二分类Logistics 回归分析用于评估预测HCC微血管侵犯的最佳MRI预测指标。采用二分类Logistic回归筛选HCC早期复发的预测因子。采用单元与多元Cox回归分析对早期复发有关联的影响因素进行分析。采用Kaplan-Meier生存分析评估微血管侵犯的早期和总体生存情况。 结果 在多元二分类Logistics 回归分析中,肿瘤>5 cm(OR=7.1,95% CI:1.3~38.8,P=0.023)、瘤周动脉期强化(OR=2.1,95%CI:0.8~5.5,P=0.018)和非光滑肿瘤边缘(OR=3.3,95%CI:1.0~10.5,P=0.045)是与微血管侵犯相关的预测征象。在多元Cox回归分析模型中,微血管侵犯差异无统计学意义(P=0.09)。Kaplan-Meier曲线显示,存在微血管侵犯患者早期和总体复发率更高。 结论 MRI征象中,肿瘤>5 cm、瘤周动脉期强化和非光滑肿瘤边缘是预测HCC微血管侵犯的独立预测因子。微血管侵犯是影响预后的重要指标,但预测早期复发的能力欠佳。

关键词: 肝细胞肝癌, 磁共振成像, 微血管侵犯, 早期复发, 诊断

Abstract: Objective To investigate the significance of preoperative contrast-enhanced multiphase magnetic resonance imaging(MRI)in the identification of microvascular invasion and early recurrence in patients with hepatocellular carcinoma(HCC). Methods This retrospective study included 169 HCC patients treated with surgical resection during Feb. 2015 and Jan. 2019 who underwent preoperative multiphase MRI. Clinical, biologic and imaging features associated with microvascular invasion and early recurrence(within 2 years)were analyzed. MRI predictors for microvascular invasion were evaluated with univariate and multivariate Logistics analysis. Predictors of early recurrence were determined with Logistic regression and multivariate Cox analysis. Early recurrence and overall recurrence in microvascular invasion were evaluated with Kaplan-Meier analysis. Results In multivariate Logistics analysis, tumor size >5 cm(OR=7.1, 95%CI: 1.3-38.8,P=0.023), corona enhancement(OR=2.1, 95%CI: 0.8-5.5, P=0.018), and non-smooth tumor margin(OR=3.3, 95%CI: 1.0~10.5, P=0.045)were independent significant variables associated with microvascular invasion. In multivariate Cox analysis, microvascular invasion was a non-statistically significant factor(P=0.09). Kaplan-Meier curve showed that patients with microvascular invasion had lower early and overall recurrence-free survival. Conclusion Tumor size >5 cm, corona enhancement, and non-smooth tumor margin are independent predictors for microvascular invasion in HCC. Microvascular invasion is an important prognostic indicator but with a poor ability to predict early recurrence.

Key words: Hepatocellular carcinoma, Magnetic resonance imaging, Microvascular invasion, Early recurrence, Diagnosis

中图分类号: 

  • R574
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