钆塞酸二钠增强MRI列线图术前预测双表型肝细胞癌及根治切除术后复发的价值  

The value of gadoxetic acid-enhanced MRI nomogram in preoperative prediction of dual-phenotype hepatocellular carcinoma and recurrence after radical resection

作　　者：金震滨 徐磊 张学琴 张涛 JIN Zhen-bin;XU Lei;ZHANG Xue-qin(.Department of Radiology,Affiliated Nantong Hospital 3 of Nantong University,Jiangsu 226000,China)

机构地区：[1]南通大学附属南通第三医院/南通市第三人民医院影像科,江苏南通226000

出　　处：《放射学实践》2024年第11期1488-1493,共6页Radiologic Practice

基　　金：南通市卫生健康委员会科研课题(MS2023071);南通市市级科技计划项目(MS2023069)。

摘　　要：目的:探讨基于钆塞酸二钠增强MRI的列线图术前对双表型肝细胞癌(DPHCC)的预测及评估术后无复发生存率(RFS)的价值。方法:回顾性分析2015年1月-2020年6月在本院行肝切除术的160例HCC患者,分为DPHCC组(80例)和非DPHCC组(80例)。收集两组患者术前临床及影像学资料,并进行随访。单因素和多因素Logistic回归分析确定DPHCC的独立危险因素,并构建列线图,当Youden指数最大时将患者分为高、低风险亚组,采用Kaplan-Meier法及Log-rank检验比较患者的RFS。结果:肿瘤边缘不规则(OR=2.745,95%CI:1.259~5.985,P=0.017)、动脉期环形强化(OR=3.665,95%CI:1.429~9.396,P=0.038)及肝胆期病灶与肝脏相对信号强度比值(RIR)较低(OR=0.037,95%CI:0.002~0.653,P=0.012)是DPHCC的独立预测因素。列线图曲线下面积(AUC)为0.723(95%CI:0.646~0.790)。基于多因素Logistic回归分析结果及Youden指数将患者分为高风险组(评分>5.9)和低风险组(评分≤5.9)。高风险组患者中位RFS显著低于低风险组(P=0.001),与组织学DPHCC和非DPHCC患者(P=0.005)相似。结论:基于钆塞酸二钠增强MRI构建的列线图有助于术前预测DPHCC及评估其预后。Objective:To investigate the value of nomogram based on gadoxetic acid-enhanced MRI in the preoperative prediction of dual-phenotype hepatocellular carcinoma(DPHCC)and the evaluation of recurrence-free survival(RFS).Methods:160 HCC patients who underwent hepatectomy in our hospital from January 2015 to June 2020 were retrospectively analyzed,and divided into DPHCC group(n=80)and non-DPHCC group(n=80).Preoperative clinical and imaging data of the two groups were collected and followed up.Univariate and multivariate independent risk factors for DPHCC,and a nomogram was constructed,Patients were divided into high and low risk groups when the Youden index was maximum,Kaplan-Meier method and Log-rank test were used to compare the RFS of patients.Results:Irregular tumor margin(OR=2.745,95%CI:1.259~5.985,P=0.017),rim arterial phase hyperenhancement(OR=3.665,95%CI:1.429~9.396,P=0.038)and lower relative signal intensity ratio(RIR)of hepatobiliary phase(OR=0.037,95%CI:0.002~0.653,P=0.012)were independent risk factors of DPHCC.The area under the curve(AUC)of the nomogram is 0.723(95%CI:0.646~0.790).Based on the results of multivariate Logistic regression analysis and Youden index,the patients were divided into high-risk group(score>5.9)and low-risk group(score≤5.9).The median RFS in the high-risk group was significantly lower than that in the low-risk group(P=0.001),and similar to that of histological DPHCC and non-DPHCC patients(P=0.005).Conclusion:The nomogram based on gadoxetic acid-enhanced MRI is useful for preoperative prediction and prognosis assessment of DPHCC.

关 键 词：肝肿瘤 双表型肝细胞癌 磁共振成像 列线图 无复发生存率 

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]