超声造影对肝细胞癌经动脉化疗栓塞治疗完全缓解病灶预测分析

摘要/Abstract

摘要： 目的分析超声造影(CEUS)预测肝细胞癌(HCC)经动脉化疗栓塞治疗(TACE)后病灶缓解情况。方法搜集2019年6月—2021年7月期间郑州大学第二附属医院TACE术后CEUS复查评估患者46例(男40例、女6例),年龄56(41, 68)岁。TACE治疗疗效参照疗效评价标准(RECIST),记录病灶灭活情况,其中病灶内血流及增强信号未见为完全缓解(CR),其余为未CR病例。比较CR和未CR病例一般资料,分析影响HCC患者TACE术后病灶缓解的危险因素,计算TACE对CR病灶的诊断表现。结果 46例HCC病例中共观察到46个病灶,其中CR 16例(CR组),未CR 30例(未CR组)。CR组肿瘤直径为2.5(1.5, 4.0)cm,显著小于未CR组[4.5(3.0, 6.5)cm, Z=11.028, P<0.05];CR组动脉期增强和环状增强分别为7例(43.8%)和2例(12.5%),与未CR组[26例(86.7%)、17例(56.7%)]相比,差异具有统计学意义(χ²=-9.480, χ²=-8.496, P<0.05);CR组环状增强厚度为0.0(0.0, 0.0)cm,显著小于未CR组[0.3(0.0, 0.7)cm, Z=-9.004, P<0.05]。将肿瘤直径、动脉期增强、环状增强及环状增强厚度作为自变量,HCC患者TACE治疗后缓解情况作为应变量(赋值0=CR,1=未CR),纳入logistic回归,结果显示肿瘤直径、环状增强及环状增强厚度是HCC患者TACE治疗后未获得CR的独立预测因素(P<0.05)。以DSA或肝活检病理结果为金标准,CEUS诊断HCC患者TACE术后CR敏感度、特异度、准确度、阳性预测值及阴性预测值分别为81.2%(13/16)、93.3%(28/30)、89.1%(41/46)、86.7%(13/15)及93.2%(41/44)。结论 CEUS可用于预测HCC患者TACE治疗后病灶CR情况,而肿瘤直径、环状增强及环状增强厚度是影响患者治疗后未获得CR的独立预测因素。

关键词: 肝细胞癌, 经动脉化疗栓塞治疗, 超声造影

Abstract: Objective To investigate contrast-enhanced ultrasound (CEUS) in predicting the clinical remission of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods A total of 46 patients (40 males and 6 females) who underwent CEUS after TACE from June 2019 to July 2021 were enrolled, with an average of 56 (41, 68) years. The efficacy of TACE was recorded according to the evaluation criteria of efficacy (RECIST), in which no blood flow or enhancement signal in the focus was defined as complete remission (CR), and the rest were non-CR. The general data of CR and non-CR cases were compared. The risk factors affecting the remission of lesions after TACE in HCC patients were analyzed, and evaluate the diagnostic value of CEUS. Results A total of 46 lesions were observed in 46 HCC cases, including 16 cases of CR (CR group) and 30 cases of non-CR (non-CR group). The tumor diameter of CR group was 2.5 (1.5, 4.0) cm, which was significantly smaller than that of non-CR group [4.5 (3.0, 6.5) cm, Z=11.028, P<0.05]. The proportions of arterial phase enhancement and annular enhancement in CR group were 7 cases (43.8%) and 2 cases (12.5%), which were significantly different from those in non-CR group [26 cases (86.7%) and 17 cases (56.7%)], the differences were statistically significant (χ²=-9.480, χ²=-8.496, P<0.05). The thickness of annular enhancement in CR group was 0.0 (0.0,0.0) cm, which was significantly lower than that in non-CR group [0.3 (0.0, 0.7) cm, Z=-9.004, P<0.05]. Tumor diameter, arterial enhancement, annular enhancement and annular enhancement thickness were taken as independent variables, remission of HCC patients after TACE treatment was taken as dependent variable (assigned 0 = CR, 1= no CR). The results of logistic regression indicated that tumor diameter, annular enhancement and annular enhancement thickness were independent predictors for incomplete remission in HCC patients after TACE treatment (P<0.05). Taking the results of digital subtraction angiography (DSA) or liver biopsy as the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing CR were 81.2% (13/16), 93.3% (28/30), 89.1% (41/46) and 86.7% (13/15), respectively. Conclusion CEUS can be used to predict the CR of HCC patients after TACE. Tumor diameter, annular enhancement and annular enhancement thickness are independent risk factors.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Contrast-enhanced ultrasound

高新选, 甄艳华, 李会霞. 超声造影对肝细胞癌经动脉化疗栓塞治疗完全缓解病灶预测分析[J]. 肝脏, 2022, 27(10): 1084-1087.

GAO Xin-xuan, ZHEN Yan-hua, LI Hui-xia. Contrast-enhanced ultrasound in predicting complete remission of hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. Chinese Hepatolgy, 2022, 27(10): 1084-1087.

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