CT引导肝癌微波消融术后CT灌注参数与近期疗效及预后的关系研究

周炜; 耿娜薇; 王颖; 臧伟; 刘丙木; 曹莉明

doi:10.16766/j.cnki.issn.1674-4152.003724

CT引导肝癌微波消融术后CT灌注参数与近期疗效及预后的关系研究

doi: 10.16766/j.cnki.issn.1674-4152.003724

周炜¹,
耿娜薇¹,
王颖¹,
臧伟¹,
刘丙木¹,
曹莉明^2, ,

1.
保定市第一中心医院介入治疗科，河北保定 071000
2.
联勤保障部队第九八零(白求恩国际和平)医院介入治疗科，河北石家庄 050082

基金项目:

河北省医学科学研究重点课题项目 20211761

详细信息

通讯作者:
曹莉明，E-mail：290718029@qq.com

中图分类号: R445.4 R735.7
计量
- 文章访问数: 30
- HTML全文浏览量: 17
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-22
- 网络出版日期: 2024-12-28

The relationship between CT perfusion parameters, short-term efficacy and prognosis after CT-guided microwave ablation of hepatocellular carcinoma

1.
Department of Interventional Radiology, Baoding First Central Hospital, Baoding, Hebei 071000, China

摘要

摘要: 目的术前CT灌注成像有利于肝癌患者的预后评估，但关于术后CT灌注成像作用的研究较少。本研究分析CT引导肝癌微波消融术(MWA)后CT灌注成像参数与肝癌患者近期疗效和远期预后的关系，以进一步探究其在肝癌患者中的应用价值。方法选取保定市第一中心医院2020年1月—2022年1月收治的原发性肝癌患者150例，根据改良实体瘤疗效评价标准(mRECIST)分为治疗有效组和治疗无效组。比较2组MWA治疗4周后CT灌注参数，应用ROC曲线评价CT灌注参数预测患者近期疗效的价值；以全因死亡为终点事件，使用Kaplan-Meier生存曲线评估CT灌注参数与患者预后的关系并应用log-rank检验进行差异性比较。结果治疗有效组肝动脉灌注量(HAP)低于治疗无效组、门静脉灌注量(PVP)高于治疗无效组(P < 0.001)；HAP、PVP对患者近期疗效有一定的预测价值，其中二者联合检测预测效能最高，AUC为0.894，灵敏度、特异度分别为94.64%、65.96%；HAP低水平组、PVP高水平组总体生存率分别高于HAP高水平组、PVP低水平组(P < 0.05)。结论 CT灌注参数与肝癌患者MWA后短期疗效和长期预后均密切相关，术后HAP越高、PVP越低，患者治疗效果和预后越差。
- 肝癌 /
- CT /
- 微波消融术 /
- 疗效 /
- 预后
Abstract: Objective Preoperative CT perfusion imaging is beneficial to the prognosis assessment of patients with liver cancer, but there are few studies on the effect of postoperative CT perfusion imaging. This study analyzed the relationship between CT perfusion imaging parameters and short-term efficacy and long-term prognosis of patients with liver cancer after CT-guided microwave ablation (MWA), so as to further explore its application value in patients with liver cancer. Methods A total of 150 patients with primary liver cancer admitted to Baoding First Central Hospital from January 2020 to January 2022 were selected and separated into the effective group and the ineffective group according to the modified response evaluation criteria in solid tumor (mRECIST). CT perfusion parameters between the two groups were compared after 4 weeks of MWA treatment, and the receiver operating characteristic (ROC) curve was used to evaluate the value of CT perfusion parameters in predicting the short-term efficacy; With all-cause death as the end event, Kaplan-Meier survival curve was used to evaluate the relationship between CT perfusion parameters and prognosis of patients, and log-rank test was used to compare the differences. Results Hepatic artery perfusion volume (HAP) in the effective group was lower than that in the ineffective group, and the portal vein perfusion volume (PVP) was higher (P < 0.001); Both HAP and PVP had certain predictive value for the short-term efficacy of patients, and their combined detection had the highest predictive efficacy, with AUC of 0.894, sensitivity and specificity of 94.64% and 65.96%, respectively; The overall survival rate of HAP low-level group and PVP high-level group was higher than that of HAP high-level group and PVP low-level group (P < 0.05). Conclusion CT perfusion parameters are closely related to the short-term efficacy and long-term prognosis of HCC patients after MWA. The higher the HAP and lower the PVP, the worse the therapeutic effect and prognosis.
- Liver cancer /
- CT /
- Microwave ablation /
- Curative effect /
- Prognosis

HTML全文

图 1 CT灌注参数对肝癌患者近期疗效的预测价值

Figure 1. Predictive value of CT perfusion parameters for the short-term curative effect in patients with liver cancer

下载: 全尺寸图片幻灯片

图 2 肝癌MWA后不同HAP患者生存情况比较

Figure 2. Comparison of survival of different HAP patients after microwave ablation of hepatocellular carcinoma

下载: 全尺寸图片幻灯片

图 3 肝癌MWA后不同PVP患者生存情况比较

Figure 3. Comparison of survival of different PVP patients after microwave ablation of hepatocellular carcinoma

下载: 全尺寸图片幻灯片

表 1 2组原发性肝癌患者CT灌注参数比较[x±s，mL/(min·100 mL)]

Table 1. Comparison of CT perfusion parameters between the effective treatment group and the ineffective treatment group[x±s, mL/(min·100 mL)]

组别	例数	HAP	PVP
治疗有效组	94	22.07±4.29	95.43±20.27
治疗无效组	56	41.86±10.53	74.68±16.82
t值		16.138	6.449
P值		＜0.001	＜0.001

下载: 导出CSV

表 2 CT灌注参数对肝癌患者近期疗效的预测价值

Table 2. The predictive value of CT perfusion parameters for the short-term curative effect in patients with liver cancer

项目	截点值	AUC	95% CI	P值	约登指数	灵敏度(%)	特异性(%)
HAP	31.80 mL/(min·100 mL)	0.877	0.813~0.925	＜0.001	0.677	91.07	76.60
PVP	94.19 mL/(min·100 mL)	0.851	0.784~0.904	＜0.001	0.540	92.86	67.02
联合检测		0.894	0.833~0.938	＜0.001	0.606	94.64	65.96

下载: 导出CSV

参考文献(23)

[1]	GILLES H, GARBUTT T, LANDRUM J. Hepatocellular Carcinoma[J]. Crit Care Nurs Clin North Am, 2022, 34(3): 289-301. doi: 10.1016/j.cnc.2022.04.004
[2]	杨帆, 曹毛毛, 李贺, 等. 1990—2019年中国人群肝癌流行病学趋势分析及预测[J]. 中华消化外科杂志, 2022, 21(1): 106-113. YANG F, CAO M M, LI H, et al. Analysis and prediction of the epidemiological trend of liver cancer in the Chinese population from 1990 to 2019[J]. Chinese Journal of Digestive Surgery, 2022, 21(1): 106-113.
[3]	吴景, 毕京浩, 袁蕙芸, 等. 1990—2019年肝癌伤残调整寿命年的研究现状及变化趋势[J]. 中国肿瘤, 2022, 31(11): 915-923. WU J, BI J H, YUAN H Y, et al. Research status and trends of disability-adjusted life years for liver cancer from 1990 to 2019[J]. Journal of Oncology, 2022, 31(11): 915-923.
[4]	张天澜, 路营, 雷进, 等. 多次微波消融对原发性肝癌患者术后肝功能的影响[J]. 解放军医学院学报, 2023, 44(7): 733-738, 799. ZHANG T L, LU Y, LEI J, et al. Effect of repeated microwave ablation on postoperative liver function in patients with hepatocellular carcinoma[J]. Academic Journal of Chinese Pla Medical School, 2023, 44(7): 733-738, 799.
[5]	王雅晳, 于杰, 程志刚, 等. 经皮微波消融早期原发性肝癌预后因素分析[J]. 中华超声影像学杂志, 2022, 31(3): 252-259. WANG Y X, YU J, CHENG Z G, et al. Microwave ablation of early-stage hepatocellular carcinoma affects survival prognostic factors[J]. Chinese Journal of Ultrasonography, 2022, 31(3): 252-259.
[6]	HAJ-MIRZAIAN A, KADIVAR A, KAMEL I R, et al. Updates on imaging of liver tumors[J]. Curr Oncol Rep, 2020, 22(5): 46. DOI: 10.1007/s11912-020-00907-w.
[7]	王德生, 苏庆杰, 夏诗亮, 等. CT灌注成像参数与前循环急性缺血性脑卒中静脉溶栓患者临床转归的相关性[J]. 中国现代医学杂志, 2022, 32(13): 8-14. WANG D S, SU Q J, XIA S L, et al. Correlation between CTP parameters and clinical outcomes in patients with acute anterior circulation ischemic stroke after intravenous thrombolysis[J]. China Journal of Modern Medicine, 2022, 32(13): 8-14.
[8]	ROMANO F, CHIARELLI M, GARANCINI M, et al. Rethinking the barcelona clinic liver cancer guidelines: intermediate stage and child-pugh B patients are suitable for surgery?[J]. World J Gastroenterol, 2021, 27(21): 2784-2794. doi: 10.3748/wjg.v27.i21.2784
[9]	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 中华肝脏病杂志, 2020, 28(2): 112-128. National Health Commission of the People ' s Republic of China Medical Administration. Guidelines for diagnosis and treatment of primary liver cancer in China (2019 edition)[J]. Chinese Journal of Hepatology, 2020, 28(2): 112-128.
[10]	LLOVET J M, LENCIONI R. mRECIST for HCC: performance and novel refinements[J]. J Hepatol, 2020, 72(2): 288-306. doi: 10.1016/j.jhep.2019.09.026
[11]	曹毛毛, 李贺, 孙殿钦, 等. 全球肝癌2020年流行病学现状[J]. 中华肿瘤防治杂志, 2022, 29(5): 322-328. CAO M M, LI H, SUN D Q, et al. Global epidemiology of liver cancer in 2020[J]. Chinese Journal of Cancer Prevention and Treatment, 2022, 29(5): 322-328.
[12]	ANWANWAN D, SINGH S K, SINGH S, et al. Challenges in liver cancer and possible treatment approaches[J]. Biochim Biophys Acta Rev Cancer, 2020, 1873(1): 188314. DOI: 10.1016/j.bbcan.2019.188314.
[13]	周俭, 肖永胜. 肝癌肝移植临床研究现状与展望[J]. 中国实用外科杂志, 2020, 40(1): 37-41. ZHOU J, XIAO Y S. Present status and progress of clinical liver transplantation for hepatocellular carcinoma[J]. Chinese Journal of Practical Surgery, 2020, 40(1): 37-41.
[14]	IZZO F, GRANATA V, GRASSI R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update[J]. Oncologist, 2019, 24(10): e990-e1005. doi: 10.1634/theoncologist.2018-0337
[15]	JOHNSON W, WEEKLEY A, SUZ P, et al. Safety of CT-guided microwave ablation of subcardiac liver tumors[J]. Cardiovasc Intervent Radiol, 2022, 45(11): 1693-1700. doi: 10.1007/s00270-022-03235-7
[16]	闫兰竹, 乔顺义, 张艳丽, 等. 免疫球蛋白在肝癌TACE治疗过程中的变化及预测疗效的价值[J]. 昆明医科大学学报, 2024, 45(4): 128-134. YAN L Z, QIAO S Y, ZHANG Y L, et al. Changes of Immunoglobulin in TACE Treatment of Hepatocellular Carcinoma and Its Value in Predicting Curative Effect[J]. Journal of Kunming Medical University, 2024, 45(4): 128-134.
[17]	陆小华, 袁洪新. BTLA、CTLA-4基因多态性与肝癌TACE联合靶向治疗疗效及预后相关性[J]. 昆明医科大学学报, 2023, 44(9): 126-135. LU X H, YUAN H X. The Analysis of the Correlation between BTLA, CTLA-4 Gene Polymorphisms and the Efficacy and Prognosis of TACE Combined Targeted Therapy for Liver Cancer[J]. Journal of Kunming Medical University, 2023, 44(9): 126-135.
[18]	陈庭宇, 王涛, 龚齐云, 等. 多层螺旋CT灌注成像评价介入性热化疗治疗中晚期肝癌的价值[J]. 影像科学与光化学, 2020, 38(2): 272-279. CHEN T Y, WANG T, GONG Q Y, et al. Value of Multi-slice Spiral CT Perfusion Imaging in Evaluating Interventional Thermochemotherapy for Advanced Hepatocellular Carcinoma[J]. Imaging Science and Photochemistry, 2020, 38(2): 272-279.
[19]	孙文杰, 高知玲, 高雨佳, 等. 基于多层螺旋CT全肝灌注成像小肝癌射频消融术后早期血流状态变化的定量评价[J]. 中华肝脏病杂志, 2020, 28(6): 488-493. SUN W J, GAO Z L, GAO Y J, et al. Quantitative evaluation of early stage blood flow change status after radiofrequency ablation based on multi-slice spiral CT whole-liver perfusion imaging on small hepatocellular carcinoma[J]. Chinese Journal of Hepatology, 2020, 28(6): 488-493.
[20]	盖雪, 李国华, 付荣, 等. 多层螺旋CT灌注扫描联合血清FABP5、SEMA-3B对老年原发性肝癌的诊断和预后评估价值[J]. 中国老年学杂志, 2023, 43(15): 3639-3642. GAI X, LI G H, FU R, et al. The value of multi-slice spiral CT perfusion scanning combined with serum FABP5 and SEMA-3B in the diagnosis and prognosis of aged primary liver cancer[J]. Chinese Journal of Gerontology, 2023, 43(15): 3639-3642.
[21]	孟明明, 董健, 刘福全, 等. CT肝脏灌注成像对PHC患者TACE术后血流状态的评估[J]. 影像科学与光化学, 2022, 40(4): 837-842. MENG M M, DONG J, LIU F Q, et al. Evaluation of Blood Flow Status after TACE in PHC Patients by CT Liver Perfusion Imaging[J]. Imaging Science and Photochemistry, 2022, 40(4): 837-842.
[22]	LEWIN M, LAURENT-BELLUE A, DESTERKE C, et al. Evaluation of perfusion CT and dual-energy CT for predicting microvascular invasion of hepatocellular carcinoma[J]. Abdom Radiol (NY), 2022, 47(6): 2115-2127.
[23]	KOBE A, KINDLER Y, KLOTZ E, et al. Fusion of preinterventional MR imaging with liver perfusion CT after RFA of hepatocellular carcinoma: early quantitative prediction of local recurrence[J]. Invest Radiol, 2021, 56(3): 188-196.