瘤内动脉联合肿瘤形态分型对肝细胞癌微血管侵犯的预测价值

摘要

目的 探讨肝细胞癌(HCC)患者术前特异性影像学特征——瘤内动脉和肿瘤结节分型对微血管侵犯(MVI)的发生以及患者预后的预测价值.方法 回顾性分析2008年1月至2014年12月在南京鼓楼医院行肝部分切除术的220例HCC患者的临床影像及病理资料.采用单因素和多因素Logistic回归分析术前特异性影像学特征和临床资料对MVI的预测价值.通过Kaplan-Meier生存分析和Cox比例风险模型分析其对HCC患者预后的影响.结果 单因素和多因素Logistic回归分析结果显示术前CT出现瘤内动脉和不规则型肿瘤形态是MVI仅有的两个独立预测因素,我们将其称为MVI影像预测因子(RPMVI).其受试者工作特征曲线(ROC)下面积为0.830(95％ CI,0.769～0.891;P＜0.05).Cox多因素分析显示Child-Pugh分级、肿瘤＞5 cm、RPMVI、MVI和非解剖性肝切除术是影响HCC患者总生存率和无瘤生存率的独立危险因素.存在RPMVI的患者术后l、3、5年总生存率分别为83.3％、61.7％、40.1％;无RPMVI的患者分别为97.1％、76.5％、69.6％ (P ＜0.05).存在RPMVI的患者术后1、3、5年无瘤生存率分别为61.9％、36.9％、28.4％;无RPMVI的患者分别为81.6％、61.9％、52.2％ (P ＜0.05).结论 RPMVI可以较准确地预测MVI的发生,其敏感性和特异性较高.与MVI类似,RPMVI是影响HCC预后的独立危险因素,可为HCC外科治疗方案的制订提供重要依据.%Objective To investigate the predictive values of preoperative radiological features-intratumoral arteries and tumoral morphological classification on microvascular invasion (MVI) and on prognosis in patients with hepatocellular carcinoma (HCC).Methods A total of 220 consecutive HCC patients who underwent curative hepatectomy at Nanjing Drum Tower Hospital from January 2008 to December 2014 were retrospectively analyzed.The predictive values of preoperative radiological features and clinical data on MVI were analyzed by the univariate analysis and multivariate logistic regression methods.The prognosis of HCC patients was analyzed by the Kaplan-Meier survival analysis and the Cox proportional hazards models.Results Univariate analysis and multivariate logistic regression showed intratumoral arteries and tumoral morphological classification using preoperative CT[called the radiological predictorsof microvascular invasion (RPMVI)] to be independent predictors of MVI.The AUROC for RPMVI inpredicting MVI was O.830 (95％ CI,O.769 ～ 0.891,P ＜0.05).The Cox multivariate analysis identified Child-Pugh grading,tumor size ＞ 5 cm,RPMVI,MVI and non-anatomical liver resection to be independent risk factorsof overall survival (OS),while tumor size ＞ 5 cm,RPMVI,MVI and non-anatomical liver resection to be independent risk factor sofre currence-free survival (RFS).The 1-,3-,and 5-year OS rates were 83.3％,61.7％,and 40.1％ in patients with RPMVI and 97.1％,76.5％,and 69.6％ in patients without RPMVI (P ＜0.05),respectively.The 1-,3-,and 5-year RFS rates were 61.9％,36.9％,and 28.4％ in patients with RPMVI and 81.6％,61.9％,and 52.2％ in patients without RPMVI (P ＜ 0.05),respectively.Conclusions RPMVI is a novel radiological marker that accurately predicted histological MVI in HCC patients preoperatively.Similar to MVI,RPMVI was found to be an independent risk factor for prognosisin HCC patients,and it may provide the important information for surgical treatment planning in HCC patients.