摘要
目的探讨依据肝细胞癌(下简称肝癌)的术前临床资料及CT增强影像特征在预测微血管侵犯及根治性切除术后早期复发(1年内复发)中的价值。方法回顾性分析2014年4月至2015年5月期间于我院行肝癌根治性切除术的病例150例,对可能影响肝癌患者微血管侵犯及根治性切除术后早期复发的术前临床资料及CT增强影像特征行单因素及多因素分析。结果单因素分析结果显示,与无微血管侵犯和无早期复发者比较,有微血管侵犯和有早期复发者的病灶较大(P=0.002、P=0.005)、肿瘤边缘不光滑(P<0.001、P<0.001)及病灶多发(P=0.005、P=0.038)所占比例较高,而有微血管侵犯者的包膜不完整(P=0.032)所占比例较高,有早期复发者无包膜及包膜不完整所占比例较高(P=0.038)且癌灶门脉期CT值百分比较高(P=0.049)、癌灶门脉期相对洗脱率较高(P=0.020),其余术前临床资料及CT增强影像特征在有微血管侵犯和有早期复发者和无微血管侵犯及无早期复发者间比较差异均无统计学意义(P>0.05)。多因素logistic逐步回归分析结果显示,肿瘤边缘不光滑(OR=7.075,P<0.001;OR=4.125,P<0.001)和肿瘤多灶性(OR=3.290,P=0.008;OR=2.354,P=0.047)是预测微血管侵犯和根治性切除术后早期复发的重要因素;同时有早期复发者门脉期较快廓清(OR=1.023,P=0.017)。结论肿瘤边缘不光滑和肿瘤多灶性是肝癌微血管侵犯和根治性切除术后早期复发的独立危险因素,有早期复发者在门脉期较快廓清。术前影像检查对预测微血管侵犯和根治性切除术后早期复发有一定的价值,有助于选择合理的治疗方案及预测预后。
Objective To assess value of preoperative clinical data and enhanced CT imaging features in predic- tion of microvascular invasion （MVI） and early recurrence （recurrence in one year） after curative resection for hepatoce- llular carcinoma （HCC）. Methods A retrospective analysis was conducted for 150 patients with HCC who underwent curative tumor resection in West China Hospital of Sichuan University from April 2014 to May 2015. The roles of preoperative CT characteristics and clinical data on MVI and early recurrence after curative tumor resection were evaluated by univariate and multivariate analyses. Results Compared with HCC with no MVI and no early recurrence after curative resection, univariate analysis results showed that HCC with MVI and early recurrence had larger tumor size （P=0.002, P=0.005）, a higher proportion of non-smooth tumor margin （P〈0.001, P〈0.001）, and tumor multifocality （P=0.005, P=0.038）, HCC with MVI had a higher proportion of incomplete tumor capsule （P=0.032）, HCC with early recurrence had a higher proportion of incomplete and absence tumor capsules （P=0.038） and a faster washout on portal venous phase--the percentage attenuation ratio on the portal venous phase （P=0.049） and relative washout ratio on the portal venous phase （P=0.020） were higher. A multivariate logistic regression analysis results showed that non-smooth tumor margin （OR=7.075, P〈0.001; OR=4.125, P〈0.001） and tumor multifocality （OR=3.290, P=0.008; OR=2.354, P=0.047） were the independent predictors for MVI and early recurrence after curative tumor resection, HCC with early recurrence also had a faster washout on the portal venous phase （OR=1.023, P=0.017）. Conclusions Non-smooth tumor margin and tumor multifocality are independent risk factors for MVI and early recurrence after curative tumor resection, and HCC with early recurrence has a faster washout on portal venous phase. Preoperative enhanced CT imaging could predict MVI and early recurrence after curative tumor resection and CT imaging findings are helpful to choose reasonable treatment and predict prognosis.
出处
《中国普外基础与临床杂志》
CAS
2016年第11期1400-1406,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝细胞癌
CT增强
根治性切除
微血管侵犯
早期复发
危险因素
Hepatocellular carcinoma
CT enhanced imaging
Curative tumor resection
Microvascular invasion
Early recurrence
Risk factors
