早期肝细胞癌术后复发患者CT影像特点及预测价值  

CT Image Features of Patients with Recurrence after Operation for Early Hepatocellular Carcinoma and Their Predictive Value

作　　者：张则才 杨丽兵 曹英伟 韩明利[2] ZHANG Ze-cai;YANG Li-bing;CAO Ying-wei;HAN Ming-li(Depatment of Hepatobiliary Surgery,People’s Hospital of Hebi,Hebi 458030,Henan Province,China;Department of General Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]鹤壁市人民医院肝胆外科,河南鹤壁458030 [2]郑州大学第一附属医院普外科,河南郑州450000

出　　处：《中国CT和MRI杂志》2025年第1期119-121,共3页Chinese Journal of CT and MRI

基　　金：国家自然科学(82072932);河南省医学科技攻关计划项目省部共建重点项目(SBGJ2020002034)。

摘　　要：目的 分析早期肝细胞癌(HCC)术后复发患者电子计算机断层扫描(CT)影像特点及预测价值。方法 回顾性选取2019年5月至2022年4月我院收治的58例行肝切除术的早期HCC患者的临床资料。根据术后复发情况,将患者分为复发组(31例)和未复发组(27例),比较两组患者基线资料、 CT影像学特征,使用Logistic逐步回归分析导致早期HCC患者术后复发的独立危险因素;绘制受试者工作特征曲线,以曲线下面积(AUC)评价各危险因素对早期HCC患者术后复发的预测效能。结果 两组基线资料比较,差异无统计学意义(P>0.05)。两组肿瘤最大直径、肿瘤边界及微血管侵犯比较,差异有统计学意义(P<0.05);两组肿瘤数目、肿瘤包膜、动脉期肿瘤周边强化、肿瘤内坏死、肿瘤卫星灶、供血方式、癌灶动脉期及门脉期CT值百分比比较,差异无统计学意义(P>0.05)。Logistic回归分析结果显示,肿瘤边界不光滑、有微血管侵犯、肿瘤最大直径增大为早期HCC术后复发的独立危险因素(P<0.05)。肿瘤边界、微血管侵犯、肿瘤最大直径预测早期H CC术后复发的A U C分别为0.711、0.633、0.866,三者联合预测的AUC为0.958(95%CI:0.870~0.993),敏感度为90.32%,特异度为92.59%,联合预测因子AUC高于单独指标(Z=3.539、2.247、7.838,P≤0.001、0.025、<0.001)。结论肿瘤边界、微血管侵犯、肿瘤最大直径与早期HCC患者术后复发呈明显相关性,可作为术后复发风险的预测指标,且联合检测可提高预测价值。Objective To analyze computed tomography(CT)image features of patients with recurrence after operation for early hepatocellular carcinoma(HCC),and their predictive value.Methods The clinical data of 58 early patients with HCC who underwent hepatectomy in the hospital from May 2019 to April 2022 were collected retrospectively.According to postoperative recurrence,patients included were divided into recurrence group(31 cases)and non-recurrence group(27 cases).Baseline data and CT image features of the two groups were compared,and logistic stepwise regression analysis was conducted to identify the independent risk factors for postoperative recurrence in patients with early HCC.The predictive efficacy of each risk factor for postoperative recurrence in patients with early HCC was evaluated using the area under the curve(AUC).Results Baseline data of the two groups were comparable(P>0.05).There were statistically significant differences in the maximum tumor diameter,tumor boundary and microvascular invasion between the two groups(P<0.05).There was no statistically significant difference in the number of tumors,tumor capsule,tumor peripheral enhancement in a rterial phase,intratumoral necrosis,satellite lesions,blood supply mode,or percentage of CT value in arterial phase and portal phase between the two groups(P>0.05).The results of logistic regression analysis showed that rough tumor boundaries,microvascular invasion,and increased maximum tumor diameter were independent risk factors for postoperative recurrence of early HCC(P<0.05).The AUC values of tumor boundary,microvascular invasion and maximum tumor diameter for predicting postoperative recurrence of early HCC were 0.711,0.633 and 0.866,respectively.The AUC of prediction using the three in combination was 0.958(95%CI:0.870-0.993).The sensitivity and specificity were 90.32%and 92.59%.The AUC of combined prediction was higher than that of prediction using a single indicator(Z=3.539,2.247,7.838,P≤0.001,0.025,<0.001).Conclusion Tumor boundary,microvascular invasio

关 键 词：早期肝细胞癌 术后复发 影像特点 预测价值 

分 类 号：R575[医药卫生—消化系统]