QCT评估HCC患者身体组分变化联合肿瘤标志物预测其术后转移的价值  

Study on the value of QCT to evaluate changes in body composition and tumor markers in predicting postoperative metastasis in HCC patients

作　　者：张钦 韩剑剑 李培 吕磊 翟建 ZHANG Qin;HAN Jian-jian;LI Pei(Department of Radiology,the First Affiliated Hospital of Southern Anhui Medical College(Yijishan Hospital),Anhui 241000,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院)放射科,安徽241000 [2]浙医二院国际医学中心影像科,杭州311200 [3]南京市第一医院影像科,南京210006

出　　处：《放射学实践》2025年第1期73-77,共5页Radiologic Practice

摘　　要：目的:基于QCT评估HCC患者身体组分变化预测其术后转移的价值。方法:回顾性分析皖南医学院第一附属医院住院治疗的73例HCC患者的临床及影像学资料。记录术前及术后1年患者的L1/L2椎体平均骨密度(BMD)、L3椎体水平总脂肪面积(TFA)、L3椎体水平腹内脂肪面积(VFA)、L3椎体水平椎后肌群脂肪面积(FA)、L3椎体水平椎后肌群肌肉面积(MA),并计算术前与术后各指标的差值(术后-术前),记为ΔBMD、ΔTFA、ΔVFA、ΔFA、ΔMA;同时记录术前血清学指标,包括甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、甲胎蛋白异质体百分比(AFP-L3/AFP)、CEA、CA-199、CA125、中性粒细胞绝对值、淋巴细胞绝对值、中性粒细胞百分比、淋巴细胞百分比。根据术后1年临床及影像学资料提示的肝内或肝外转移情况,分为转移组(29例)和非转移组(44例)。比较两组间以上指标的差异,采用ROC曲线评估相关指标预测HCC患者术后发生转移的效能。结果:转移组与非转移组的ΔMA、AFP、AFP-L3、AFP-L3百分比、中性粒细胞绝对值、淋巴细胞绝对值、中性粒细胞百分比、淋巴细胞百分比差异有统计学意义(P<0.05)。ROC曲线分析结果显示,AFPL3、AFPL3百分比、淋巴细胞绝对值、中性粒百分比、淋巴百分比、ΔMA预测HCC患者术后发生转移的AUC值分别为0.725、0.779、0.664、0.709、0.707、0.864(P均<0.05)。结论:QCT可以有效评估HCC患者术后身体组分变化,术后椎后肌群肌肉含量减少、术前高水平的AFPL3、AFPL3百分比、淋巴细胞绝对值、中性粒细胞百分比、淋巴细胞百分比可能成为预测HCC患者术后发生转移的危险因素。Objective:To evaluate the changes in body composition of HCC patients based on quantitative computed tomography(QCT)and explore its value in predicting postoperative metastasis.Methods:The clinical and imaging data of 73 HCC patients who were hospitalized at the First Affiliated Hospital of Wannan Medical College were retrospectively analyzed.The mean bone mineral density(BMD)of the L1/L2 vertebrae,total fat area(TFA)at the L3 vertebrae level,abdominal fat area(VFA)at L3 vertebrae level,fat area(FA)at L3 vertebrae level and muscle area(MA)at the L3 vertebrae level were recorded before surgery and one year after surgery.The difference between preoperative and postoperative values was calculated asΔBMD,ΔTFA,ΔVFA,ΔFA,ΔMA;Preoperative serum biomarkers were also recorded:including alpha-fetoprotein(AFP),AFP-L3,the AFP-L3/AFP ratio,carcinoembryonic antigen(CEA),CA-199,CA125,absolute value of neutrophil,absolute lymphocyte count,neutrophil percentage,and lymphocyte percentage.Based on clinical and imaging data one year after surgery,patients were divided into a metastatic group(29 patients)and a non-metastatic group(44 patients).The differences of these indicators between the two groups were compared,and the predictive ability of these indicators for postoperative metastasis was assessed using ROC curves.Results:Significant differences were found between the metastatic and non-metastatic groups inΔMA,AFP,AFP-L3,AFP-L3 ratio,absolute neutrophil count,absolute lymphocyte count,neutrophil percentage,and lymphocyte percentage(P<0.05).ROC curve analysis showed that the area under the curve(AUC)values for AFP-L3,AFP-L3 ratio,absolute lymphocyte count,neutrophil percentage,lymphocyte percentage,andΔMA in predicting postoperative metastasis were 0.725,0.779,0.664,0.709,0.707 and 0.864,respectively(all P<0.05).Conclusion:PQCT can effectively assess postoperative changes in body composition in HCC patients.A reduction in the muscle content of the paravertebral muscle group after surgery,along with high preoperative levels

关 键 词：肝细胞癌 定量计算机断层扫描 体层摄影术 X线计算机 身体组分 血清标志物 肿瘤转移 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]