MRI和临床危险因素对中晚期肝细胞癌首次D-TACE近期疗效预测价值分析  

The value of MRI and clinical risk factors in predicting the short-term efficacy of initial D-TACE in patients with intermediate and advanced stage hepatocellular carcinoma

作　　者：隰子涵 杨永波[1] 邵国良[2] XI Zihan;YANG Yongbo;SHAO Guoliang(Department of Radiology,Zhejiang Provincial Cancer Hospital,Hangzhou,Zhejiang Province 310005,China)

机构地区：[1]浙江省肿瘤医院放射科,浙江杭州310005 [2]浙江省肿瘤医院介入治疗科,浙江杭州310005

出　　处：《介入放射学杂志》2024年第4期376-381,共6页Journal of Interventional Radiology

基　　金：国家自然科学基金(82072032);浙江省医药卫生科技计划项目(2023KY598、2021KY567)。

摘　　要：目的探讨肝细胞癌(HCC)患者术前增强MRI影像学特征及相关临床资料与首次药物洗脱微球-经导管动脉化疗栓塞术(D-TACE)近期疗效的关系。方法回顾性分析113例中晚期HCC患者临床及MRI影像学资料。依据近期疗效分为客观缓解(OR)组(n=74)和非OR组(n=39)。采用单因素及多因素logistic回归分析筛选出与D-TACE近期疗效相关的独立因素。采用Kaplan-Meier法计算无疾病进展期(PFS),Log-rank检验反映近期疗效与PFS关系。通过Cox比例风险回归确定与PFS相关影响因素。结果多因素logistic回归分析结果显示,前白蛋白低(OR=1.012,P=0.029)、载药量多(OR=0.969,P=0.016)、肿瘤/肝脏体积比高(OR=0.001,P=0.007)、肿瘤边缘强化程度重(OR=0.239,P=0.049)与首次D-TACE近期疗效显著相关。OR组、非OR组中位PFS分别为8.5个月、4.5个月,OR组预后更佳(χ^(2)=4.903,P=0.027)。Cox比例风险回归分析显示首次D-TACE近期疗效好、肿瘤最大径大、肿瘤/肝脏体积比小是PFS保护因素。结论HCC患者肿瘤/肝脏体积比低、前白蛋白高、载药量少、肿瘤边缘强化程度轻,首次D-TACE近期疗效更可能达到OR,PFS更长。Objective To explore the relationship of preoperative contrast-enhanced MRI(CE-MRI)imaging features and related clinical information to the short-term outcomes and progression-free survival(PFS)in patients with hepatocellular carcinoma(HCC)after receiving initial drug eluting microspheres transcatheter arterial chemoembolization(D-TACE)treatment.Methods The clinical data and MRI imaging materials of 113 patients with intermediate and advanced stage HCC were retrospectively analyzed.Based on short-term efficacy,the patients were divided into objective response(OR)group(n=74)and non-OR group(n=39).Univariate and multivariate logistic regression analyses were used to screen out the independent factors related to the short-term outcome of D-TACE.PFS was calculated by using Kaplan-Meier method,and the correlation between short-term outcome and PFS was determined by Log-rank testing.Factors associated with PFS were determined by Cox proportional risk regression.Results Multivariate logistic regression analysis showed that lower prealbumin(OR=1.012,P=0.029),higher drug load of microspheres(OR=0.969,P=0.016),higher tumor/liver volume ratio(OR=0.001,P=0.007),and marginal enhancement degree of tumor(OR=0.239,P=0.049)were significantly associated with short-term efficacy of initial D-TACE.The median PFS in OR group and non-OR group was 8.5 and 4.5 months respectively,the prognosis in OR group was better(χ^(2)=4.903,P=0.027).COX proportional risk regression analysis showed that better short-term efficacy after the initial D-TACE,larger maximum diameter of the tumor,and small tumor/liver volume ratio were the protective factors for PFS.Conclusion HCC patients having low tumor/liver volume ratio,high preoperative prealbumin level,lower drug load of microspheres,slight tumor marginal enhancement are more likely to achieve a short-term efficacy of OR and to have a longer PFS after the initial D-TACE.

关 键 词：肝细胞癌 药物洗脱微球 经导管动脉化疗栓塞术 多参数磁共振成像 无疾病进展期 

分 类 号：R735.7[医药卫生—肿瘤]