摘要
目的探讨超声弹性成像联合血清学检查对肝细胞癌微血管侵犯(MVI)的预测价值。方法回顾性分析2018年1月至2020年9月期间在福建医科大学孟超肝胆医院行肝脏肿瘤切除术的288例肝细胞癌患者的临床资料。术后病理MVI阴性104例患者作为MVI阴性组,阳性184例患者作为MVI阳性组。对比两组患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血小板、白蛋白、甲胎蛋白等血清学指标。对比两组患者肝脏肿瘤边缘1 cm处硬度(S1)、2 cm处硬度(S2)、S1S2index(S1/S2×10)、肿瘤长径等影像学指标。多因素分析筛选出预测肝细胞癌MVI的独立危险因素,并构建列线图模型。结果共入选肝细胞癌患者288例,其中男性225例,女性63例,年龄(56.3±9.7)岁。多因素logistic回归分析显示,肿瘤多发(OR=2.47,95%CI:1.41~4.33,P=0.002)、肿瘤长径越大(OR=1.21,95%CI:1.08~1.36,P=0.031)、AFP>400μg/L(OR=2.83,95%CI:1.54~5.22,P=0.015)、S1S2index越高(OR=1.33,95%CI:1.17~1.51,P=0.025)的肝细胞癌患者MVI发生率越高。根据上述危险因素构建的列线图模型可直观显示肝细胞癌MVI的风险,预测值与真实值之间符合度的平均绝对误差为0.021。受试者工作特征曲线对列线图模型预测肝细胞癌MVI的曲线下面积为0.777(95%CI:0.720~0.835)。结论肿瘤多发、肿瘤长径越大、AFP>400μg/L和S1S2index越高是肝细胞癌患者MVI的独立危险因素,以此建立的列线图模型可较为准确地预测肝细胞癌MVI的风险,可为临床诊疗工作中治疗方案的选择提供参考。
Objective To study the predictive value of combining ultrasound elestography with serological examination on incidences of microvascular invasion(MVI)in patients with hepatocellular carcinoma(HCC).Methods The clinical data of 288 patients with HCC who underwent liver resection at MengChao Hepatobiliary Hospital of Fujian Medical University from January 2018 to September 2020 were retrospectively analyzed.104 MVI-negative and 184 MVI-positive patients who were confirmed by postoperative histopathology were divided into the MVI-negative and MVI-positive groups respectively.Serological indicators of alanine aminotransferase,aspartate aminotransferase,platelet,albumin,and alpha-fetoprotein were compared between groups.Imaging indexes including elasticity at liver tumor surrounding 1 cm area(S1),elasticity at liver tumor surrounding 2 cm area(S2),S1S2index(S1/S2×10)and longest tumor diameter were compared between groups.Multi-variate analysis was used to screen out independent risk factors in predicting MVI of hepatocellular carcinoma,and then a nomogram model was constructed.Results Of 288 patients with HCC who met the inclusion criteria of this study,there were 225 males and 63 females,aged(56.3±9.7)years.Multivariate logistic regression analysis revealed that patients with HCC who had multiple tumors(OR=2.47,95%CI:1.41-4.33,P=0.002),long tumor diameter(OR=1.21,95%CI:1.08-1.36,P=0.031),AFP>400μg/L(OR=2.83,95%CI:1.54-5.22,P=0.015),a high S1S2index(OR=1.33,95%CI:1.17-1.51,P=0.025)had high incidences of MVI.The nomogram model constructed from these risk factors showed the risk of MVI in HCC patients with a mean absolute deviation of compliance between the predicted value and the true value being 0.021.The receiver operating characteristic(ROC)curve showed that the area under ROC curve of the nomogram model which predicted MVI of HCC patients was 0.777(95%CI:0.720-0.835).Conclusions Multiple tumors,long tumor diameter,AFP>400μg/L and a high S1S2 index were independent risk factors for MVI in HCC patients.The nomogra
作者
陈惠春
涂海斌
林健玲
Chen Huichun;Tu Haibin;Lin Jianling(Department of Ultrasound,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第10期744-747,共4页
Chinese Journal of Hepatobiliary Surgery
基金
福建医科大学启航基金(2019QH1302)。
关键词
癌
肝细胞
超声检查
多普勒
彩色
血清学试验
微血管侵犯
Carcinoma,hepatocellular
Ultrasonography,Doppler,color
Serologic tests
Microvascular invasion
