肝细胞癌微血管侵犯患者增强CT表现及肿瘤直径观察

肝脏 ›› 2021, Vol. 26 ›› Issue (10): 1103-1106.

肝细胞癌微血管侵犯患者增强CT表现及肿瘤直径观察

盛宝华, 毕腾飞, 王华宇

223001 淮安市第一人民医院分院放射科

收稿日期:2021-02-02 出版日期:2021-10-31 发布日期:2021-12-07
通讯作者: 王华宇,Email:973184353@qq.com
基金资助:
淮安市科技项目(HAB201726)

Enhanced CT findings and tumor diameter in patients with microvascular invasion of hepatocellular carcinoma

SHENG Bao-hua, BI Teng-fei, WANG Hua-yu

Department of Radiology, the First People's Hospital of Huai'an, Jiangsu 223001, China

Received:2021-02-02 Online:2021-10-31 Published:2021-12-07
Contact: WANG Hua-yu,Email:973184353@qq.com

摘要/Abstract

摘要： 目的研究肝细胞癌微血管侵犯患者增强CT表现及肿瘤直径变化。方法回顾性分析2017年10月至2020年10月淮安市第一人民医院接受手术治疗的68例肝细胞癌患者临床资料,按照其有无血管侵犯将其分为侵犯组(n=35)和未侵犯组(n=33)。比较两组CT增强扫描表现(边缘强化程度、肿瘤包膜情况、瘤灶分型、瘤内动脉情况、瘤灶数量)及肿瘤直径,Logistic回归分析增强CT表现及肿瘤直径预测肝细胞癌微血管侵犯的危险因素。结果未侵犯组有肿瘤包膜、单结节型瘤灶、无瘤内动脉、肿瘤直径＜5 cm患者比例高于侵犯组,分别为(66.67%比40.00%)、(66.67%比22.86%)、(60.61%比31.43%)、(66.67%比28.57%),差异均有统计学意义(P＜0.05)。经Logistic回归性分析证实,肿瘤包膜无或不完整(β=1.864,P=0.034,95%CI=1.154~36.073)、瘤灶分型非单结节型(β=0.984,P=0.022,95%CI=1.154~6.196)、有瘤内动脉(β=1.494,P=0.040,95%CI=1.074~18.488)、肿瘤直径≥5 cm(β=1.908,P=0.026,95%CI=1.258~36.122)是肝细胞癌微血管侵犯的危险因素。结论术前通过增强CT扫描及肿瘤直径观察对辨别肝细胞癌微血管侵犯有较高价值。

关键词: 肝细胞癌, 微血管侵犯, 增强CT扫描

Abstract: Objective To investigate the enhanced computer tomography (CT) findings and tumor diameter in patients with microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Methods The clinical data of 68 patients with HCC who received surgical treatment in our hospital from October 2017 to October 2020 were retrospectively analyzed. They were divided into invasion group (n=35) and non invasion group (n=33) according to whether complicated with vascular invasion. Enhanced CT findings (edge enhancement, tumor capsule, tumor classification, intratumoral artery, tumor number) and tumor diameter were compared between two groups. The differences between the 2 groups were included in the logistic regression analysis model to evaluate CT findings and tumor diameter and find risk factors of MVI in patients with HCC. Results The proportion of the existence of tumor capsule (66.67% vs 40.00%), single tumor focus (66.67% vs 22.86%), no intratumoral artery (60.61% vs 31.43%) and tumor diameter < 5 cm (66.67% vs 28.57%) of non invasion group were significantly higher than those of invasion group (P<0.05). Logistic regression analysis showed that the risk factors of MVI in patients with HCC were non-capsule or incomplete tumor capsule (β=1.864, P=0.034, 95%CI=1.154 ~ 36.073), non single tumor focus (β=0.984, P=0.022, 95%CI=1.154 ~ 6.196), intratumoral artery (β=1.494, P=0.040, 95%CI=1.074 ~ 18.488) and tumor diameter ≥5 cm (β=1.908, P=0.026, 95%CI=1.258~36.122). Conclusion Enhanced CT scan and tumor diameter observation have a high value in diagnosing MVI of patients with HCC before operation.

Key words: Hepatocellular carcinoma, Microvascular invasion, Enhanced computer tomography scan

盛宝华, 毕腾飞, 王华宇. 肝细胞癌微血管侵犯患者增强CT表现及肿瘤直径观察[J]. 肝脏, 2021, 26(10): 1103-1106.

SHENG Bao-hua, BI Teng-fei, WANG Hua-yu. Enhanced CT findings and tumor diameter in patients with microvascular invasion of hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(10): 1103-1106.

参考文献

[1] 陈晖, 左琳琳, 李木松, 等.肝细胞癌患者射频消融术治疗10年长期有效性分析.肝脏,2020, 25:922-925.
[2] Murali A, Patil S, Phillips K, et al. Locoregional therapy with curative intent versus primary liver transplant for hepatocellular carcinoma: systematic review and meta-analysis. Transplantation, 2017, 101:249-257.
[3] 张涛, 顾梁瑞, 陈文, 等.原发性肝细胞癌微血管侵犯的影像学研究进展.影像诊断与介入放射学, 2019, 28:374-378.
[4] Maucort-Boulch D, Demartel C, Franceschi S, et al. Fraction and incidence of liver cancer attributable to hepatitis b and c viruses worldwide.Int J Cancer, 2018, 142:2471-2477.
[5] 中国抗癌协会肝癌专业委员会, 中华医学会肝病学分会肝癌学组, 中国抗癌协会病理专业委员会,等. 原发性肝癌规范化病理诊断指南(2015年版). 解放军医学杂志, 2015, 40:241-246.
[6] Reis S P, Sutphin P D, Singal A G, et al. Tumor enhancement and heterogeneity are associated with treatment response to drug-eluting bead chemoembolization for hepatocellular carcinoma. J Comput Assist Tomogr, 2017, 41:289-293.
[7] 丁光宇, 朱小东, 施国明,等. 微血管侵犯对肝内胆管细胞癌根治性切除术患者预后的影响. 中华肝胆外科杂志, 2018, 24:189-193.
[8] 张小峰, 汪宇, 王文超,等. 微血管侵犯在肝癌外科治疗中的临床意义. 肝胆外科杂志, 2017, 25:7-10.
[9] 郑丽荣, 沈俊颐, 陈卫霞,等. CT增强扫描预测肝细胞癌微血管侵犯、根治性切除术后早期复发. 中国普外基础与临床杂志, 2016, 23:1400-1406.
[10] Derek J, Erstad, Kenneth K, et al. Prognostic and therapeutic implications of microvascular invasion in hepatocellular carcinoma. Ann Surg Oncol, 2019, 26:1474-1493.
[11] 蒋涵羽, 陈婕, 张晗媚,等. 肝细胞癌微血管侵犯的术前诊断与评估. 放射学实践, 2018, 33:80-84.
[12] 王雪雪, 贾宁阳, 邵丹丹,等. 能谱CT三期增强在鉴别肝脏局灶性结节增生和肝细胞癌中的价值. 中国医学计算机成像杂志, 2017, 23:427-432.
[13] 杨振宇. 多结节肝细胞癌的基础研究及治疗策略. 临床肝胆病杂志, 2016, 32:1212-1215.
[14] 杨薇霖, 陈卫霞. 肝脏神经内分泌肿瘤与肝细胞癌的CT影像学特征分析. 中国普外基础与临床杂志, 2017, 24:1524-1531.
[15] 白石磊, 杨平华, 李俊, 等. 微血管侵犯对小肝细胞癌和大肝细胞癌术后远期预后的影响. 中华肝脏外科手术学电子杂志,2017, 6:207-211.