摘要
目的:探讨表观扩散系数(ADC)对经导管肝动脉栓塞化疗(TACE)即时联合射频消融治疗的孤立性大肝癌患者预后的预测价值。方法:回顾性分析解放军总医院第一医学中心介入放射科2014年12月至2018年7月连续收治的40例行TACE即时联合射频消融治疗的孤立性大肝癌患者资料,其中男性34例,女性6例,平均年龄55.9岁。所有患者于治疗前1周内及术后1个月行腹部MRI增强检查。受试者工作特征(ROC)曲线评估ADC预测疗效的价值。Kaplan-Meier法绘制生存曲线并以log-rank检验比较生存率。采用Cox比例风险模型进行单因素和多因素预后分析。结果:40例患者治疗后完全缓解18例,部分缓解12例,客观缓解率75.0%(30/40)。ADC预测TACE即时联合射频消融治疗有效(完全缓解+部分缓解)的ROC曲线下面积为0.86(95%CI:0.74~0.98),最佳界值为1.32×10-3 mm 2/s,灵敏度为0.63,特异度为1.00。高ADC组(≥1.32×10-3mm 2/s,n=19)无进展生存率和累积生存率均优于低ADC组(<1.32×10-3mm 2/s,n=21),差异有统计学意义(均P<0.05)。多因素分析,ADC<1.32×10-3mm 2/s(HR=3.711,95%CI:1.705~8.074,P<0.05)是患者无进展生存的独立危险因素,ADC<1.32×10-3mm 2/s(HR=3.518,95%CI:1.016~12.185,P<0.05)是总体生存的独立危险因素。结论:术前ADC是孤立性大肝癌患者行TACE即时联合射频消融治疗预后的独立危险因素,对预后预测具有一定的价值。
Objective To study the predictive value of pretreatment apparent diffusion coefficient(ADC)on prognosis in patients with isolated large hepatocellular carcinoma(SLHCC)treated by combined transcatheter arterial chemoembolization(TACE)and radiofrequency ablation(RFA).Methods A retrospective analysis was performed on 40 patients with SLHCC who were treated at the Department of Interventional Radiology,the First Medical Center of PLA General Hospital from December 2014 to July 2018,with combined TACE and RFA.There were 34 males and 6 females,with an average age of 55.9 years.All patients underwent enhanced abdominal MRI within 1 week before and 1 month after treatment.The receiver operating characteristic(ROC)curve was used to assess the predictive efficacy value of ADC.The survival curves were plotted by the Kaplan-Meier method and compared with the log-rank test.Univariate and multivariate prognostic analyses were performed using the Cox proportional hazard models.Results After treatment,there were 18 patients with complete response and 12 with partial response.The objective response rate was 75.0%(30/40).The area under ROC curve of ADC in predicting the effectiveness of TACE combined with RFA(complete response+partial response)was 0.86(95%CI:0.74-0.98).The optimal threshold was 1.32×10-3 mm2/s,the sensitivity was 0.63,and the specificity was 1.00.The progression-free survival rate and cumulative survival rate in the high ADC group(≥1.32×10-3mm2/s,n=19)were better than that in the low ADC group(<1.32×10-3mm2/s,n=21),with significant differences(both P<0.05).On multivariate analysis,ADC<1.32×10-3mm2/s(HR=3.711,95%CI:1.705-8.074;P<0.05)was an independent risk factor for progression-free survival,while ADC<1.32×10-3mm2/s(HR=3.518,95%CI:1.016-12.185,P<0.05)was an independent risk factor for overall survival.Conclusion Preoperative ADC was an independent risk factor for prognosis in patients with SLHCC undergoing TACE combined with RFA.It has value in prognostic prediction.
作者
唐静
李金锋
刘凤永
袁宏军
李鑫
田晓梅
纪刊
Tang Jing;Li Jinfeng;Liu Fengyong;Yuan Hongjun;Li Xin;Tian Xiaomei;Ji Kan(Medical School of Chinese PLA,Beijing 100853,China;Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Interventional Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第11期816-820,共5页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金(81271673,81671800)
北京市自然科学基金(7172204)
北京市科技新星课题(2011118)。
关键词
癌
肝细胞
表观扩散系数
经导管肝动脉栓塞化疗
射频消融
Carcinoma,hepatocellular
Apparent diffusion coefficient
Transcatheter arterial chemoembolization
Radiofrequency ablation
