术前影像学评分联合肿瘤标志物对肝细胞癌TACE术后预后评估价值的研究  

Preoperative Imaging Score Combined with Tumor Marker to Evaluatethe Prognosis of Hepatocellular Carcinoma after TACE

作　　者：夏志颖 杜福川[1] XIA Zhiying;DU Fuchuan(Department of Radiology,Hainan Traditional Chinese Medicine Hospital,Haikou 570203,Hainan,P.R.China)

机构地区：[1]海南省中医院放射科,海南海口570203

出　　处：《影像科学与光化学》2023年第6期320-325,共6页Imaging Science and Photochemistry

摘　　要：探讨术前影像学肿瘤负荷评分(TBS)联合血清甲胎蛋白(AFP)对肝细胞癌(HCC)患者经动脉化疗栓塞术(TACE)术后预后评估价值。收集87名接受TACE手术的HCC患者的临床及影像资料,根据CT增强影像计算TBS评分。使用Kaplan-Meier生存曲线和对数秩检验进行组间总生存期(OS)比较。结果显示,HCC患者TACE术后中位生存期为20.5个月,平均TBS评分为9.52±3.26。3年OS随着TBS的升高而逐渐降低(P<0.001);TBS≤9.9和TBS>9.9患者间OS差异有统计学意义(P<0.001)。患者TACE术前AFP水平与OS呈中等程度负相关(r=-0.519;P<0.001),与AFP<400 ng/mL的患者相比,AFP≥400 ng/mL患者的OS更差(P=0.001)。多因素分析显示TBS≤9.9且AFP≥400 ng/mL(HR:5.449;95%CI:1.951~15.217;P=0.01)、TBS>9.9且AFP<400 ng/mL(HR:13.576;95%CI:5.873~31.382;P<0.001)和TBS>9.9且AFP≥400 ng/mL(HR:27.854;95%CI:8.950~86.683;P<0.001)均是肝细胞癌患者TACE术后OS的独立预测因素,且TBS≤9.9且AFP<400 ng/mL患者的OS好于其他三组(P<0.05)。因此,基于影像学的TBS评分结合AFP水平对进行TACE的HCC患者预后评估具有较高的价值。To evaluate the value of imaging tumor burden score(TBS)combined with serum alpha-fetoprotein(AFP)in the prognosis of hepatocellular carcinoma(HCC)after transarterial chemo-embolization(TACE).Clinical and imaging data of 87 HCC patients who underwent TACE were collected.The TBS scores were calculated from CT-enhanced images.OS was compared between groups using Kaplan-Meier survival curves and log-rank test.The median survival of HCC patients after TACE was 20.5 months,and the mean TBS score was 9.52±3.26.The results showed that the 3-year OS decreased progressively with increasing TBS(P<0.001);the difference in OS between patients with TBS≤9.9 and TBS>9.9 was statistically significant(P<0.001).Patients’pre-TACE AFP levels were moderately negatively correlated with OS(r=-0.519;P<0.001),and OS was worse in patients with AFP≥400 ng/mL compared with those with AFP < 400 ng/mL ( P =0.001). Multifactorial analysis showed that patients with TBS≤9.9 and AFP≥400 ng/mL (HR: 5.449;95%CI: 1.951-15.217;P =0.01), TBS>9.9 and AFP<400 ng/mL (HR: 13.576;95%CI: 5.873-31.382;P <0.001) and TBS>9.9 and AFP≥400 ng/mL (HR:27.854;95%CI: 8.950- 86.683;P < 0.001 ) were both independent predictors of OS after TACE in patients with hepatocellular carcinoma, and the OS of patients with TBS≤9.9 and AFP<400 ng/mL was better than the other three groups ( P <0.05). Therefore, the image-based TBS score combined with AFP level has a high value in the prognosis assessment of HCC patients with TACE.

关 键 词：肝细胞癌 经动脉化疗栓塞术 肿瘤负荷评分 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤]