LI-RADS 4/5类和M类增殖型肝细胞癌的影像特征及根治切除术后复发研究  

Imaging features and recurrence-free survival after curative resection of proliferative hepatocellular carcinoma with LI-RADS category 4/5 and category M

作　　者：陈丹丹 徐磊 张学琴 张涛 CHEN Dan-dan;XU lei;ZHANG Xue-qin(Department of Radiology,Affiliated Nantong Hospital 3 of Nantong University/the Third People's Hospital of Nantong,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》2025年第3期362-368,共7页Radiologic Practice

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

摘　　要：目的:探讨肝脏影像报告和数据系统2018版(LI-RADS v2018)分类为LR-4/5类和LR-M类孤立性增殖型肝细胞癌(HCC)的术前预测因素,并评估结合LI-RADS分类和增殖对HCC根治性切除术后复发的影响。方法:回顾性纳入肝硬化背景术前行钆塞酸二钠(Gd-EOB-DTPA)增强并经根治性切除术后病理证实为孤立性HCC患者。比较LR-4/5类和LR-M类增殖型和非增殖型HCC的临床、病理和影像特征。采用最小收缩和选择算子(LASSO)回归和多因素Logistic回归分析筛选出不同LI-RADS分类中增殖型HCC的术前独立危险因素。采用单因素和多因素Cox回归分析评估病理分类和LI-RADS分类与术后无复发生存期(RFS)的关系。采用Kaplan-Meier法和Log-rank检验比较不同LI-RADS分类和病理分类患者的RFS。结果:共纳入206例孤立性HCC患者,LR-4/5类中非增殖型HCC比例(69.2%)更高,LR-M类中增殖型HCC比例(68.0%)更高。LR-4/5类中肿瘤内动脉(OR=3.777,95%CI:1.733~8.234,P=0.001)和不光滑的肿瘤边缘(OR=3.204,95%CI:1.465~7.007,P=0.004)是增殖型HCC的独立危险因素。LR-M类中大量实质低强化(OR=9.061,95%CI:2.133~38.490,P=0.003)是增殖型HCC的独立危险因素。多因素Cox回归分析显示LI-RADS分类是HCC术后RFS的独立预测因子(HR=2.116,95%CI:1.369~3.270,P=0.001)。结合LI-RADS和病理分类,非增殖型LR-4/5类RFS最高,其次是增殖型LR-4/5类,非增殖型和增殖型LR-M类RFS较差。结论:LR-4/5类和LR-M类中增殖型HCC的独立危险因素不同。结合LI-RADS分类和增殖有助于对孤立性HCC根治性切除术后复发进行风险分层。Objective:To investigate the preoperative predictive factors for identifying proliferative hepatocellular carcinomas(HCC)based on the Liver Imaging Reporting and Data System(LI-RADS)v2018 category 4/5(LR-4/5)and category M(LR-M),and evaluate their impacts on recurrence after curative resection.Methods:This retrospective study included cirrhotic patients with histopathological confrmed solitary HCC after curative resection who underwent gadoxetic acid-enhanced magnetic resonance imaging(MRI).The clinical,pathological and MR imaging features in proliferative and non-proliferative with LR-4/5 and LR-M were compared.Least absolute shrinkage and selection operator(LASSO)and multivariable logistic regression analyses were performed to identify the preoperative predictive factors for proliferative hepatocellular HCC with LR-4/5 and LR-M.Univariable and multivariable cox regression analyses were performed to assess the association of LI-RADS category and pathologic classification with recurrence-free survival(RFS).The RFS of different LI-RADS category and pathologic classifcation were evaluated by using the Kaplan-Meier survival curves and log-rank test.Results:Among the 206 solitary HCCs,the percentage of non-proliferative HCCs(69.2%)was higher in LR-4/5,the percentage of proliferative HCCs(68.0%)was higher in LR-M.Intratumoral artery(OR=3.777,95%CI:1.733~8.234,P=0.001)and non-smooth tumor margin(OR=3.204,95%CI:1.465~7.007,P=0.004)were independent risk factors associated with proliferative HCC in LR-4/5.Substantial hypoenhancing component(OR=9.061,95%CI:2.133~38.490,P=0.003)was independent risk factors associated with proliferative HCC in LR-M.Multivariate cox regression analysis indicated that LI-RADS category(HR=2.116,95%CI:1.369~3.270,P=0.001)was independent factor associated with RFS.Combined LI-RADS and pathologic classifcation indicated that the RFS of non-proliferative LR-4/5 group was the highest,followed by proliferative LR-4/5 group,and the RFS of non-proliferative and proliferative LR-M groups were relatively

关 键 词：肝细胞癌 增殖亚型 磁共振成像 预后 

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]