术前磁共振成像对肝癌患者射频术后复发的预测价值

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摘要目的探讨肝癌患者术前磁共振成像(MRI)对肝癌射频术后复发的预测价值。方法选择2013-07至2019-07在武警北京总队医院及解放军总医院第五医学中心经射频消融手术治疗的肝癌患者80例,所有患者术前一周内均行MRI增强检查,随访3年内复发情况,根据是否复发分为复发组与无复发组。比较两组的一般资料和MR征象,并采用COX回归分析肝癌术后复发的影响因素。采用受试者工作特征(ROC)曲线分析各参数值预测肝癌患者射频术后复发的效能。结果随访3年中,复发19例(23.75%),未复发61例(76.25%)。两组性别、年龄、肿瘤位置及甲胎蛋白(AFP)比较,差异无统计学意义。单因素分析显示,肿瘤边缘(P=0.019)、肿瘤内脂质(P=0.013)、瘤周强化(P=0.049)、肿瘤包膜(P=0.003)、肿瘤与大血管间距(P=0.035)有统计学差异。COX多因素分析,肿瘤边缘(HR=3.049,95%CI:1.131～8.218)、肿瘤脂质(HR=0.264,95%CI:0.095～0.740)及肿瘤包膜(HR=0.305,95%CI:0.107～0.866)是肝癌患者术后复发的影响因素。肿瘤边缘、肿瘤包膜及肿瘤内脂质联合诊断肝癌术后复发的ROC曲线下面积(AUC)为0.838,敏感度与特异度分别为84.21%、73.77%;预测复发的效能高于单用肿瘤边缘、肿瘤包膜及肿瘤内脂质。结论术前MRI征象对肝癌射频术后复发情况具有一定预测价值,可为临床治疗提供参考依据。

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	潘亮

关键词 ：肝癌, 磁共振成像, 射频消融, 复发

Abstract：Objective To investigate the predictive value of preoperative magnetic resonance imaging ( MRI) for the postoperative recurrence of hepatocellular carcinoma (HCC) after radiofrequency ablation. Methods A total of 80 patients with HCC who underwent radiofrequency ablation in Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force and the Fifth Medical Center of PLA General Hospital from July 2013 to July 2019 were selected. All patients underwent contrast-enhanced MRI examination within one week before surgery, and were followed up for recurrence within three years. According to whether they had recurrence, the patients were divided into recurrence group and non-recurrence group. The general data and MR features of the two groups were compared, and COX regression was used to analyze the factors affecting postoperative recurrence of HCC. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of each parameter value in predicting the recurrence of HCC after radiofrequency ablation. Results During a 3-year follow-up, there were 19 cases (23.75%) of recurrence and 61 cases (76.25%) of no recurrence. There was no statistically significant difference in gender, age, tumor location, or alpha fetoprotein (AFP) between the two groups. Univariate analysis showed statistical differences in tumor margin (P=0.019), intratumoral fat (P=0.013), peritumoral enhancement (P=0.049), tumor capsule (P=0.003), and the spacing between tumor and large vessel (P=0.035). COX multivariate analysis showed that tumor margin (HR=3.049, 95% CI: 1.131-8.218), intratumoral fat (HR=0.264, 95% CI: 0.095-0.740), and tumor capsule (HR=0.305, 95% CI: 0.107-0.866) were the independent factors for postoperative recurrence in HCC patients. The area under ROC curve for the combined diagnosis of tumor margin, tumor capsule and intratumoral fat for postoperative recurrence of HCC was 0.838, with sensitivity and specificity of 84.21% and 73.77%, respectively, which had a higher predictive value than using tumor margin, tumor capsule, or intratumoral fat alone. Conclusions MR features have certain predictive value in predicting the recurrence of HCC after radiofrequency ablation, which can provide reference for clinical treatment.

Key words： hepatocellular carcinoma magnetic resonance imaging radiofrequency ablation recurrence

收稿日期: 2023-11-20

ZTFLH:

R81

通讯作者: 潘亮,E-mail:panbright@126.com

作者简介: 李伟,硕士,主治医师。

引用本文:

李伟, 曹丽君, 吴斌, 王倩, 孟亮亮, 潘亮. 术前磁共振成像对肝癌患者射频术后复发的预测价值[J]. 武警医学, 2024, 35(7): 613-616. LI Wei, CAO Lijun, WU Bin, WANG Qian, MENG Liangliang, PAN Liang. Predictive value of preoperative MRI for recurrence in patients with hepatocellular carcinoma after radiofrequency ablation. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(7): 613-616.

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https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I7/613

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