原发性肝癌动脉期CT表现与经肝动脉化疗栓塞疗效相关性研究

摘要

目的 分析肝癌动脉期螺旋CT表现,探讨原发性肝癌的血供特点与经肝动脉化疗栓塞疗效及预后的相关性.方法 对69例行至少3次肝动脉化疗栓塞技术(transcatheter arterial chemoembolization,TACE)治疗的原发性肝癌患者进行疗效及预后随访,并与术前螺旋CT动脉期血供分型对比分析.根据术前动脉期肿瘤CT强化程度,将其血供分为富血供型(均匀强化型+不均匀强化型)和乏血供型(强化不明显型+无明显强化型).根据随访CT肿瘤大小改变、碘油沉积情况及有无新发病变,将近期疗效分为有效和无效.结果 69例中,近期有效27例,近期无效42例.在富血供中有效26例,无效14例;而乏血供中有效仅1例,无效为28例,富血供患者近期疗效优于乏血供(χ2＝40.481,P＜0.001).同时近期有效者的生存状况亦优于无效者(χ2＝22.39,P＜0.001),其6、12、24个月的累积生存率分别为96.30%,89.89%,50.24%和80.95%,45.28%,10.65%.结论 原发性肝癌动脉期血供CT分型与TACE术后的疗效及预后相关,利用动脉期螺旋CT表现进行原发性肝癌血供评估,有助于临床预测原发性肝癌的疗效和预后.%Objective To study the correlation between CT features of arterial phase and therapeutic effects and prognosis in patients with primary liver cancer after transcatheter arterial chemoembolization(TACE).Methods Sixty - nine patients with primary liver cancer were followed up after at least three TACE.Tumors were classified as hypervascular (homogeneous and heterogeneous) or hypovascular (homogeneous and heterogeneous) based on the degree of lesions enhancement during the hepatic arterial phase before TACE.Patients were classified as responders or non - responders based on follow - up CT evidence of tumor size change, lipiodol deposition ,and the appearance of new lesions.Results We classified the 69 patients as 27 responders or 42 non - responders.There were 26 responders and 14 non -responders in hypervascular tumor patients and 1 responder and 28 non -responders in hypovascular tumor patients.A statistically significant difference between the hypervascular pattern and the hypovascular pattern was seen, the former had much better efficacy than the later( x2 = 40.481 ,P ＜ 0.001 ).Meanwhile, patients classified as responders lived significantly longer than those classified as non - responders (x2 = 22.39, P ＜ 0.001 ).The 6, 12, and 24 month survival rates were 96.30％ ,89.89％, and 50.24％, respectively , in responders and 80.95％, 45.28％ ,and 10.65％, respectively , in non - responders.Conclusions The vascular pattern of primary liver cancer on the basis of the degree of lesions enhancement during the hepatic arterial phase is related to the therapeutic effects and prognosis of patients treated by TACE.The vascular pattern of primary liver cancer based on CT arterial -phase scans may be helpful in predicting the therapeutic effect and evaluating the prognosis.