摘要
目的:探讨术后1个月ADC值变化率评估肝细胞癌(≤5.0cm)TACE疗效的界值,比较ADC值变化率与修订后实体瘤疗效评估标准(mRECIST)对预测肿瘤无进展生存期(PFS)的效能。方法:回顾性分析34例肝细胞癌(HCC)病例(41个病灶),记录TACE术前1周、术后1个月ADC值及各项临床指标,用受试者工作曲线(ROC)确定ADC值变化率界值,应用Kaplan-Meier、log-rank检验和Cox比例风险回归模型分析ADC值变化率、mRECIST与患者术后PFS是否相关和影响患者PFS的危险因素。结果:本研究中位PFS为143天,最小ADC值变化率、平均ADC值变化率预测PFS的界值分别为23.5%(P=0.004)、22.5%(P=0.007),二者对PFS的预测效能分别为0.789、0.772。按照ADC值变化率评估为有效组与无效组间PFS差异有统计学意义(P<0.05)。多因素分析显示平均ADC值变化率是PFS的独立预测因素(P<0.001)。结论:术后1个月平均ADC值变化率较mRECIST与TACE疗效间相关性更强,是对HCC术后PFS的独立预测因素。
Objective：To study the threshold of apparent diffusion coefficient（ADC）change rate one month after transcatheter arterial chemoembolization（TACE）of hepatocellular carcinoma（HCC）response to TACE and to evaluate the predictive utility of ADC changes compared with the modified RECIST（mRECIST）for prediction of progression-free survival（PFS）.Methods：Thirty-four patients（41lesions）with HCC（≤5.0cm）underwent 1.5T MR examination（including DW imaging）,one week before and one month after TACE.Receiver operating characteristic curve（ROC）was used to explore the threshold of ADC ratio.The therapeutic responses one month after TACE were assessed using ADC ratio and mRECIST.Kaplan-Meier,log-rank tests and Cox hazard model were used to assess the correlation of ADC change rate,mRECIST and PFS,and to assess the potential clinical risk factors for PFS.Results：The median PFS was 143 days,the threshold of lowest and the average ADC change rate were 23.5%（P=0.004）and 22.5%（P=0.007）respectively,the predictive utility were 0.789、0.772 respectively.Survival analyses showed PFS of effective group and PFS of non-effective group evaluated with ADC change rate were significantly different（P0.05）.Average ADC ratio was an independent predictor for PFS（P0.05）.Conclusion：The average ADC ratio one month after TACE was an independent predictor for PFS,which showed stronger association with response to TACE of HCC than mRECIST.
出处
《放射学实践》
北大核心
2016年第3期245-251,共7页
Radiologic Practice
关键词
肝肿瘤
磁共振成像
扩散加权成像
疗效评价
Liver neoplasms
Magnetic resonance imaging
Diffusion weighted imaging
Response assessment
