影像-临床多参数联合预测肝细胞癌GPC3表达的价值  

Value of image-clinical multi-parameter combination in predicting GPC3 expression in hepatocellular carcinoma

作　　者：杨正高 杨鹏程 许永生[1,2] 黎金葵 王倩 张艳利[1,2] 雷军强[1,2] Yang Zhenggao;Yang Pengcheng;Xu Yongsheng;Li Jingkui;Wang Qian;Zhang Yanli;Lei Junqiang(The First Clinical Medical School,Lanzhou University,Lanzhou 730000,China;Department of Radiology,Intelligent Imaging Medical Engineering Research Center of Gansu Province,Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province,Clinical Research Center of Radiology Medicine of Gansu Province,The First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院放射科,甘肃省智能影像医学工程研究中心,精准影像协同创新甘肃省国际科技合作基地,甘肃省放射影像医学临床医学研究中心,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2023年第2期33-38,43,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：兰州市科技发展指导性计划资助项目(2019-ZD-46);兰州大学第一医院青年基金资助项目(ldyyyn2018-12)。

摘　　要：目的探讨基于钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)影像特征和临床指标对肝细胞癌(HCC)中磷脂酰肌醇蛋白聚糖3(GPC3)表达的预测价值。方法回顾性分析129例HCC患者临床、病理、Gd-EOB-DTPA增强MRI影像资料,其中GPC3(+)101例,GPC3(-)28例。建立预测GPC3阳性表达的逻辑回归模型,采用受试者操作特征曲线下面积(AUC)评估回归模型的效能。结果年龄、乙型肝炎、甲胎蛋白(AFP)水平、非周边廓清、病灶边缘形态、肝胆期低信号、表观扩散系数(ADC)、门脉期肿瘤信号强度/肝脏信号强度、肝胆期肿瘤信号强度/肝脏信号强度在GPC3(+)和GPC3(-)组中差异具有统计学意义(均P<0.05)。AFP≥20μg/L、ADC≤1.06×10^(-3)mm^(2)/s、有非周边廓清、肿瘤边缘形态不光滑是HCC中GPC3表达的独立预测指标,联合模型预测GPC3表达的AUC为0.913,敏感度为83.2%,特异度为85.7%。结论AFP≥20μg/L、ADC≤1.06×10^(-3)mm^(2)/s、有非周边廓清、肿瘤边缘形态不光滑可以提示HCC患者中GPC3的表达,影像-临床指标联合的诊断模型可为临床提供术前无创预测GPC3的手段。Objective To study the enhanced magnetic resonance imaging based on gadolinium-ethoxybenzyl-diethy-lenetriamine pentaacetic acid(Gd-EOB-DTPA)prognostic value of magnetic resonance imaging features and clinical indicators in hepatocellular carcinoma(HCC)expression of glypican-3(GPC3).Methods The clinical,pathological and Gd-EOB-DTPA enhanced MRI images of 129 HCC patients were retrospectively analyzed,including 101 GPC3(+)cases and 28 GPC3(-)cases.A Logistic regression model was established to predict the positive expression of GPC3.The area under the curve of the receiver operating characteristic curve was used to evaluate the effectiveness of the model.Result Age,hepatitis B,alpha-fetoprotein(AFP)level,non-peripheral clearance,lesion edge shape,hepatobiliary low signal,apparent diffusion coefficient(ADC),portal stage tumor signal intensity/liver signal intensity,and specific stage tumor signal intensity/liver signal intensity were significantly different between GPC3(+)and GPC3(-)groups(all P<0.05).AFP≥20μg/L,ADC≤1.06×10^(-3) mm^(2)/s,non-peripheral clearance and unsmooth tumor edge were independent predictors of GPC3 expression in HCC.The combined model predicted the AUC of GPC3 expression as 0.913,with a sensitivity of 83.2% and specificity of 85.7%.Conclusion AFP≥20μg/L,ADC≤1.06×10^(-3) mm^(2)/s,non-peripheral clearance and non-smooth tumor edge morphology can indicate the expression of GPC3 in HCC patients.The combined clinical-imaging index diagnosis model can provide a means for preoperative non-invasive prediction of GPC3 in clinic.

关 键 词：肝细胞癌 磁共振成像 磷脂酰肌醇蛋白聚糖3 

分 类 号：R735.7[医药卫生—肿瘤]