基于临床指标和钆贝葡胺增强MRI列线图预测肝细胞癌GPC-3表达的研究  

A nomogram based on clinical factors and gadobenate dimeglumine-enhanced MRI for prediction of GPC-3 expression in hepatocellular carcinoma

作　　者：马慧 王莉 孙之 沈子剑 王传玺 赵新亚 Ma Hui;Wang Li;Sun Zhi;Shen Zijian;Wang Chuanxi;Zhao Xinya(Department of Radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Health Management Center,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Oncology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院影像科,济南250021 [2]山东第一医科大学附属省立医院健康管理中心,济南250021 [3]山东第一医科大学附属省立医院肿瘤科,济南250021

出　　处：《中华放射学杂志》2022年第11期1230-1236,共7页Chinese Journal of Radiology

基　　金：山东省自然科学基金(ZR2020MH285)。

摘　　要：目的探讨基于临床指标和钆贝葡胺增强MRI列线图预测肝细胞癌(HCC)磷脂酰肌醇蛋白聚糖-3(GPC-3)表达的价值。方法回顾性收集2018年7月至2021年6月山东第一医科大学附属省立医院经病理证实为HCC的85例患者的临床及影像资料, 患者术前行MRI平扫及钆贝葡胺增强MRI检查。根据免疫组化GPC-3的表达情况, 将患者分为GPC-3阳性组(55例)和GPC-3阴性组(30例)。收集患者临床资料, 包括性别、年龄、肝炎、肝硬化、甲胎蛋白(AFP)、丙氨酸转氨酶、天冬氨酸转氨酶、谷氨酰转移酶水平。观察MRI定性指标, 包括肿瘤边缘、环样强化、瘤内出血灶、强化包膜、卫星结节;MRI定量指标包括肿瘤最大径和钆贝葡胺增强动脉期(AP)、门静脉期(PP)、肝胆期(HBP)的肿瘤-肝实质信号比(TLR)以及肿瘤增强比(TER)。采用独立样本t检验或Mann-WhitneyU检验比较两组间定量资料, 采用χ2检验比较两组间定性资料。采用多因素logistic回归分析筛选出GPC-3表达的独立预测因素, 并建立列线图模型。运用受试者操作特征(ROC)曲线评估各独立因素及列线图的预测效能, 并使用DeLong检验比较曲线下面积(AUC)的差异。结果 GPC-3阳性与阴性组间AFP水平、肿瘤边缘、瘤内出血灶及TLR-AP、TLR-PP、TLR-HBP差异有统计学意义(P均<0.05)。多因素logistic回归结果示AFP≥20 μg/L、瘤内出血灶、TLR-HBP是HCC GPC-3阳性表达的独立预测指标(OR为3.816、4.788、0.001, P均<0.05)。建立术前临床和钆贝葡胺增强MRI预测肝细胞癌GPC-3表达的列线图模型。AFP≥20 μg/L、瘤内出血灶、TLR-HBP和列线图模型预测GPC-3阳性表达的AUC分别为0.688、0.697、0.808、0.879, 列线图模型诊断效能优于3个单独指标, 差异有统计学意义(Z=3.82、4.13、2.04, P<0.001、<0.001、=0.042)。结论基于临床指标和钆贝葡胺增强MRI定性、定量指标的列线图模型对于术前预测HCC GPC-3表达具有较好效能, Objective To investigate the predictive value of a nomogram based on clinical factors and gadobenate dimeglumine(Gd-BOPTA)-enhanced MRI for predicting the expression of Glypican-3(GPC-3)in hepatocellular carcinoma(HCC).Methods The clinical and imaging data of 85 patients with HCC confirmed by pathology in the Provincial Hospital of Shandong First Medical University from July 2018 to June 2021 were retrospectively collected.All the patients underwent Gd-BOPTA-enhanced MRI scan before operation.According to the expression of GPC-3 by immunohistochemistry,the patients were divided into GPC-3 positive group(55 cases)and GPC-3 negative group(30 cases).The clinical data of patients were collected,including gender,age,hepatitis,cirrhosis,alpha-fetoprotein(AFP),alanine aminotransferase,aspartate aminotransferase,and glutamine transferase levels.The MRI qualitative signs including tumor margin,ring enhancement,intratumoral hemorrhage,enhanced capsule,and satellite nodules were reviewed.MRI quantitative parameters including the largest tumor diameter,Gd-BOPTA-enhanced tumor-to-liver parenchyma signal ratio(TLR)and tumor enhancement ratio(TER)in arterial phase(AP),portal venous phase(PP),and hepatobiliary phase(HBP)were calculated.The independent sample t-test or Mann-Whitney U test were used to compare the quantitative data between the two groups,and theχ²test was used to compare the qualitative data between the two groups.Multivariate logistic regression analysis was used to identify the independent predictors of GPC-3 expression,and a nomogram model was established.The receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of each independent factor and nomogram,and DeLong test was used to compare differences in area under the curve(AUC).Results There were significant differences in AFP,tumor margin,intratumoral hemorrhage,and TLR-AP,TLR-PP and TLR-HBP between GPC-3 positive and negative groups(all P<0.05).Multivariate logistic regression results showed that AFP≥20μg/L,intratum

关 键 词：癌 肝细胞 磁共振成像 磷脂酰肌醇蛋白聚糖类 钆贝葡胺 列线图 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]