TACE术后320排容积CT扫描灌注参数与治疗效果的关系

摘要/Abstract

摘要： 目的探讨320排容积CT扫描灌注参数与肝癌肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗效果的关系。方法选取2019年1月至2022年6月收治的120例肝癌患者,均接受TACE手术,依据术后实体瘤疗效标准分为有效组(n=88)和无效组(n=32)。比较两组性别、年龄、侵透肝被膜、肿瘤分化程度、AFP、门脉癌栓、术中出血量、肝动脉灌注量(HAP)、肝血流量(HBF)、肝动脉灌注指数(HPI)。多因素logistic回归分析肝癌TACE治疗无效的危险因素,ROC曲线评估HAP、HBF及HPI对肝癌TACE治疗无效的预测效能,采用Pearson相关性分析CT扫描灌注参数与肝癌TACE治疗效果的关系。结果有效组和无效组侵透肝被膜为45.45%比68.75%(χ²=5.100,P=0.024)、合并门脉癌栓为43.18%比65.63%(χ²=4.729,P=0.030);而HAP(8.89±1.78比13.04±2.86,t=9.493,P<0.01)、HBF(101.24±16.83比118.08±19.66,t=4.630,P<0.01)及HPI(28.15±4.69比37.48±6.47,t=8.664,P<0.01)显著低于有效组。经多因素Logistic回归分析证实,侵透肝被膜、门脉癌栓、HAP、HBF、HPI均是影响肝癌TACE术治疗无效的危险因素,OR值分别为2.396(95%CI:1.017~5.644)、2.308(95%CI:1.030~5.632)、1.542(95%CI:1.127～2.057)、1.696(95%CI:1.026~1.804)和2.011(95%CI:1.211~2.339)。经ROC分析证实,CT扫描灌注参数HAP、HBF及HPI可用于预测肝癌TACE术治疗效果,曲线下面积分别为0.907、0.740、0.908,最佳截断值分别为10.825 mL/(min·100 mL)、112.437 mL/(min·100 mL)、31.542%(均P<0.05)。相关性分析显示,CT扫描灌注参数HAP、HBF及HPI与肝癌TACE治疗效果呈负相关(r=-0.553、-0.312、-0.448,P<0.05)。结论 CT扫描灌注参数与肝癌TACE治疗效果呈负相关,且侵透肝被膜、门脉癌栓、HAP>10.825 mL/(min·100 mL)、HBF＞112.437 mL/(min·100 mL)、HPI＞31.542%均是影响肝癌TACE治疗无效的危险因素,可作为评估肝癌TACE治疗效果的标志物。

关键词: 肝癌, 肝动脉化疗栓塞术, 320排容积CT扫描灌注参数, 治疗效果

Abstract: Objective To investigate the relationship between perfusion parameters and therapeutic effect of 320-row volume CT scan after transcatheter artery chemoembolization (TACE) for liver cancer. Methods A total of 120 patients with liver cancer admitted to our hospital from January 2019 to June 2022 were selected and studied, all of whom received TACE surgery. They were divided into the effective group (n=88) and the ineffective group (n=32) according to the postoperative efficacy criteria for solid tumors. Statistical data was compared between the two groups using χ² test. And we used t test to compare the measurement data between the two groups. The gender, age, liver envelope penetration, degree of tumor differentiation, plasma alpha-fetoprotein (AFP) concentration, portal vein cancer embolus, intraoperative blood loss, hepatic artery perfusion (HAP), hepatic blood flow (HBF), hepatic perfusion index (HPI) were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors of ineffective TACE treatment for liver cancer. Receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of HAP, HBF and HPI in predicting the failure of TACE treatment for liver cancer. Pearson correlation was used to analyze the relationship between CT perfusion parameters and TACE treatment for liver cancer. Results In the effective group and ineffective group, the comparison of Liver envelope penetration was 45.45% vs. 68.75% (χ²=5.100, P=0.024) and portal vein cancer thrombus was 43.18% vs. 65.63% (χ²=4.729, P=0.030). The proportion of patients in the ineffective group was significantly higher than that in the effective group (P<0.05). HAP (8.89±1.78 vs. 13.04±2.86, t=9.493, P=0.000), HBF (101.24±16.83 vs. 118.08±19.66, t=4.630, P=0.000) and HPI (28.15±4.69 vs. 37.48±6.47), t=8.664, P=0.000) was significantly lower than that in effective group, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis confirmed that liver envelope penetration, portal vein cancer thrombus, HAP, HBF and HPI were all risk factors affecting the efficacy of TACE treatment for liver cancer, and the OR values were 2.396 (95%CI: 1.017~5.644), 2.308 (95%CI: 1.030~5.632), 1.542 (95%CI: 1.127~2.057), 1.696 (95%CI: 1.026~1.804) and 2.011 (95%CI: 1.211~2.339) respectively. The P value were all lower than 0.05. ROC analysis proved that CT perfusion parameters HAP, HBF and HPI could be used to predict the therapeutic effect of TACE for liver cancer. The area under the curve was 0.907, 0.740 and 0.908, respectively, and the optimal cut-off value was 10.825, 112.437 and 31.542, respectively, with P<0.05. Correlation analysis showed that CT perfusion parameters HAP, HBF and HPI were negatively correlated with TACE treatment effect (r=-0.553, -0.312, -0.448, P<0.05). Conclusion Perfusion parameters of CT scan were negatively correlated with the therapeutic effect of TACE for liver cancer, and liver envelope penetration, portal vein cancer thrombus, HAP > 10.825, HBF > 112.437, HPI > 31.542 were all risk factors affecting the therapeutic effect of TACE for liver cancer. These indicators can be used as the markers to evaluate the therapeutic effect of TACE, providing reference for clinical assessment and treatment.

Key words: Liver cancer, Hepatic arterial chemoembolization, Perfusion parameters of 320-row volume CT scan, Therapeutic effect

何玉, 张学剑, 张磊. TACE术后320排容积CT扫描灌注参数与治疗效果的关系[J]. 肝脏, 2024, 29(10): 1221-1224.

HE Yu, ZHANG Xue-jian, ZHANG Lei. The relationship between perfusion parameters and treatment efficacy of 320 row volume CT scanning after TACE for liver cancer[J]. Chinese Hepatolgy, 2024, 29(10): 1221-1224.

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