钆塞酸二钠增强核磁共振成像肝胆期结节强化程度预测肝细胞癌靶向联合免疫治疗的疗效  

Increased magnetic resonance imaging enhancement of hepatobiliary nodules by gadoxetate disodium predicts the efficacy of targeted combined immunotherapy for hepatocellular carcinoma

作　　者：赵澎博 张旭 付强[2] 韩彤 李文磊 王玉柱 秦涛[2] Zhao Pengbo;Zhang Xu;Fu Qiang;Han Tong;Li Wenlei;Wang Yuzhu;Qin Tao(Department of Hepatobiliary and Pancreatic Surgery,Henan University People’s Hospital,Zhengzhou 450003,China;Department of Hepatobiliary and Pancreatic Surgery,People’s Hospital of Henan Province,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院肝胆胰腺外科,郑州450003 [2]河南省人民医院肝胆胰腺外科,郑州450003

出　　处：《中华实验外科杂志》2023年第2期342-345,共4页Chinese Journal of Experimental Surgery

基　　金：2020年度河南省留学人员科技活动择优资助项目(Z506009);2020年度河南省医学科技攻关计划省部共建重点项目(SBGJ202002012)。

摘　　要：目的利用钆塞酸二钠(Gd-EOB-DTPA)增强核磁共振成像(MRI)肝胆期的结节强化程度预测肝细胞癌(HCC)靶向联合免疫治疗的效果。方法回顾性收集2020年1月至2022年1月河南省人民医院诊断为HCC,且在靶向联合免疫治疗前行钆塞酸二钠增强MRI检查的53例患者信息,利用影像处理软件测量107个肝内结节的信号强度,计算肝胆期相对强化比(RER),并比较高强化和低强化HCC结节间的每个结节体积增加20%的时间(TTNP)。根据实体肿瘤免疫疗效评价标准(iRECIST),比较肝胆期高强化的HCC结节患者和低强化的HCC结节患者的无进展生存期(PFS)和客观缓解率(ORR)与疾病控制率(DCR)等。结果高强化HCC结节患者的中位PFS为3.4个月[95%置信区间(CI):2.5~4.3,n=21],ORR为14.3%(3/21),DCR为47.5%(10/21)。低强化HCC结节患者的中位PFS为6.8个月(95%CI:6.2~7.3,n=32),ORR为37.5%(12/32),DCR为75.0%(24/32);进展型高强化HCC结节(n=23)的中位TTNP为2.3个月(95%CI:2.0~2.6),低强化HCC结节(n=62)的中位TTNP为6.1个月(95%CI:5.0~7.2)。结论Gd-EOB-DTPA增强MRI肝胆期肝内HCC结节的强化程度与结节TTNP、PFS、DCR明显相关。Objective To predict the effect of hepatocellular carcinoma(HCC)targeted combination immunotherapy by enhancing the nodule signal intensity and enhancement of magnetic resonance imaging(MRI)HCC by gadoxetate disodium(Gd-EOB-DTPA).Methods From January 2020 to January 2022,53 patients with the clinical or pathological diagnosis as HCC in Henan Provincial People’s Hospital,undergoing gadolinated disodium enhanced MRI imaging prior to targeted combination immunotherapy,were collected retrospectively,the signal intensity of 107 intrahepatic nodules was measured by RadiAnt DICOM Viewer,as well as the relative enhancement ratio(RER)of hepatobiliary phase,and time to nodular progression(TTNP)increased by 20%of each nodule between high enhancement and low enhancement HCC nodules compared.Then,according to immune response evaluation criteria in solid tumors(iRECIST),the progression-free survival(PFS),objective response rate(ORR)and disease control rate(DCR)between high enhancement and low enhancement in hepatobiliary phase were compared.Results The median PFS of patients with highly enhanced HCC nodules was 3.4 months[95%confidence interval(CI):2.5-4.3,n=21],and that with low enhanced HCC nodules was 6.8 months(95%CI:6.2-7.3)(n=32).The median TTNP of highly enhanced HCC nodules(n=28)was 2.3 months(95%CI:2.0-2.6),and that with low enhancement(n=79)was 6.1 months(95%CI:5.0-7.2).ORR was 14.3%(3/21)and 37.5%(12/32),DCR was 47.5%(10/21)and 75.0%(24/32)in patients with or without highly enhanced intrahepatic HCC nodules,respectively.Conclusion The increased MRI median TTNP,PFS and DCR of highly enhanced hepatic HCC nodules in hepatobiliary phase by GD-EOB-DTPA are significantly shorter than low enhanced hepatic HCC nodules,so the enhanced MRI signal intensity and enhancement degree of nodules in hepatobiliary phase by GD-EOB-DTPA is a promising imaging biomarkers for predicting the efficacy of targeted combined immunotherapy in patients with liver cancer.

关 键 词：钆塞酸二钠 肝胞癌 靶向联合免疫治疗 

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]