增强CT肿瘤TER值预测Ⅰ~Ⅲ期肿块型肝内胆管癌根治术后患者预后的临床价值  

Clinical prognostic value of TER of contrast-enhanced CT for patients with stageⅠ-Ⅲmass-forming intrahepatic cholangiocarcinoma after radical resection

作　　者：王展怀[1] 张波[2] 叶垚 韩树高[3] Wang Zhanhuai;Zhang Bo;Ye Yao;Han Shugao(Department of Colorectal Surgery and Oncology,the Second Affi liated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Hepatobiliar y and Pancreatic Surgery,the Second Affi liated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Radiology,the Second Affi liated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院大肠外科,浙江杭州310009 [2]浙江大学医学院附属第二医院肝胆胰外科,浙江杭州310009 [3]浙江大学医学院附属第二医院放射科,浙江杭州310009

出　　处：《实用肿瘤杂志》2022年第3期237-243,共7页Journal of Practical Oncology

基　　金：浙江省自然科学基金项目(LY20H180015)。

摘　　要：目的拟建立基于影像学方法的Ⅰ~Ⅲ期肿块型肝内胆管癌预后模型。方法回顾性入组2011年1月至2017年12月在浙江大学医学院附属第二医院接受根治性手术的109例Ⅰ~Ⅲ期肿块型肝内胆管癌。测量术前增强CT图像中肿瘤区域的衰减值并计算肿瘤增强比(tumor enhancement ratio,TER)值。X-tile软件计算肿瘤TER值与5年总生存(overall survival,OS)率相关的最佳临界值。Kaplan-Meier法作生存分析,多因素Cox风险回归模型明确独立预后因素。结果生存分析提示,低TER组(TER值≤1.91,n=64)和高TER组(TER值>1.91,n=45)5年OS率分别为35.2%和67.2%组(P=0.003)。低TER组3年无瘤生存(disease free survival,DFS)率为35.6%,复发率为64.4%,高TER组5年DFS率为53.1%,复发率为46.9%(P=0.015)。多因素Cox回归提示,TER值是影响肿块型肝内胆管癌生存的独立预后因素(HR=1.908,95%CI:1.063~3.426,P=0.024)。结论增强CT图像中肿瘤TER值可作为Ⅰ~Ⅲ期肿块型肝内胆管癌根治术预后和复发相关一项独立的风险因素。CT影像中低TER值肿瘤患者OS及DFS低于高TER值肿瘤患者。Objective To establish an imaging-based model to predict cancer-specific survival in stageⅠ-Ⅲmass-forming intrahepat-ic cholangiocarcinoma.Methods A total of 109 patients with stageⅠ-Ⅲmass-forming intrahepatic cholangiocarcinoma who underwent radical resection from January 2011 to December 2017 in the Second Affiliated Hospital,Zhejiang University School of Medicine were ret-rospectively enrolled.The attenuation coefficient of tumor region in preoperative enhanced CT images was measured and tumor enhance-ment ratio(TER)was calculated.Patients were divided into the low-and high-enhancement groups according to the optimal cut-off value of TER for 5-year overall survival(OS)rate derived from X-tile software.Kaplan-Meier method was used for survival analysis and multi-variate Cox regression analysis was adopted to identify independent prognostic factors.Results The low-enhancement group(TER≤1.91,n=64)had a significantly lower 5-year OS rate than the high-enhancement group(TER>1.91,n=45;35.2%vs 67.2%,P=0.003).The 3-year disease free survival(DFS)rate and the recurrence rate were 35.6%and 64.4%in the low-enhancement group,and the 5-year DFS rate and the recurrence rate were 53.1%and 46.9%in the high-enhancement group(P=0.015).Multivariate Cox regression analysis showed that TER was an independent prognostic factor for the survival of mass-forming intrahepatic cholangiocarcinoma(HR=1.908,95%CI:1.063-3.426,P=0.024).Conclusions TER of contrast-enhanced CT can serve as a potential risk factor for the prognosis and recurrence of stageⅠ-Ⅲmass-forming intrahepatic cholangiocarcinoma after radical resection.The OS and DFS rates of patients with low TER were lower than those with high TER.

关 键 词：肝内胆管癌 多排螺旋CT 肿瘤标志物 

分 类 号：R735.8[医药卫生—肿瘤]