增强CT纹理参数在HBV相关肝细胞癌介入治疗效果评估中的应用

摘要/Abstract

摘要： 目的探讨增强CT纹理参数在HBV相关肝细胞癌(HCC)介入治疗预后不良预测中的效能。方法将2020年10月—2022年10月江南大学附属无锡五院收治的69例HBV相关HCC患者纳入研究。治疗前行增强CT扫描,根据肝动脉化疗栓塞(TACE)疗效分为预后不良及良好组,分别为14、55例。比较两组基线资料及增强CT纹理参数水平;以ROC曲线分析各指标对预后不良的预测价值;分析明确HCC患者TACE预后不良的危险因素。结果两组性别、年龄、BMI、肿瘤直径、吸烟人数比例、峰度差异无统计学意义(P>0.05);预后不良组门静脉转移人数比例、偏度、熵值、平均值水平(78.57 %、1.38±0.39、2.29±0.41、88.65±15.72)明显高于预后良好组(38.18 %, 0.80±0.26, 1.77±0.35, 66.94±11.07),能量水平[(1.71±0.48)×10⁶]明显低于预后良好组[(5.14±1.35)×10⁶](P<0.05)。ROC结果显示,偏度、能量、熵值、平均值预测HCC患者预后不良的曲线下面积分别为0.884、0.825、0.795、0.864(P<0.05)。Logistic回归分析结果显示,门静脉转移、偏度≥1.020、能量≤2.415×10⁶、熵值≥2.265、平均值≥80.495为HCC预后不良的危险因素(P<0.05)。结论门静脉转移及增强CT纹理参数中的偏度、能量、熵值、平均值能够用于预测HCC患者TACE治疗预后不良,临床在治疗前需对以上指标进行关注,采取措施改善患者预后。

关键词: 肝细胞癌, 增强CT, 介入治疗, 纹理参数, 疗效评估

Abstract: Objective To investigate the efficacy of enhanced CT texture parameters in predicting poor prognosis after interventional therapy for hepatitis B associated hepatocellular carcinoma (HCC). Methods A total of 69 patients diagnosed with hepatitis B-related HCC and admitted to our hospital between October 2020 and October 2022 were included in the study. The patients underwent enhanced CT scans before treatment and were then divided into two groups based on the efficacy of hepatic artery chemoembolization (TACE) for hepatocellular carcinoma: a poor prognosis group consisting of 14 patients and a good prognosis group consisting of 55 patients. Comparative analysis was conducted on baseline data and enhanced CT texture parameter levels between the two groups. The predictive value of various indicators in determining poor prognosis was evaluated through ROC curves, and risk factors associated with poor prognosis in HCC patients after TACE treatment were identified. Results No significant disparities were found in terms of gender, age, BMI, tumor diameter, proportion of smokers, and kurtosis between the two groups (P>0.05). However, the poor prognosis group exhibited notably higher values in terms of proportion, skewness, entropy and mean value of portal vein metastasis (78.57 %, 1.38±0.39, 2.29±0.41, 88.65±15.72) compared to those in the good prognosis group (38.18 %, 0.80±0.26, 1.77±0.35, 66.94±11.07). Additionally, the energy level [(1.71±0.48) ×10⁶] was significantly lower in the poor prognosis group in comparison to the good prognosis group [(5.14±1.35) ×10⁶] (P<0.05). The ROC analysis revealed that the areas under the curve of skewness, energy, entropy, and mean value in predicting poor prognosis of HCC patients were 0.884, 0.825, 0.795 and 0.864, respectively, all with statistical significance (P<0.05). Logistic regression analysis highlighted portal vein metastasis, skewness ≥ 1.020, and energy ≤ 2.415 ×10⁶, entropy value ≥ 2.265, and average value ≥ 80.495 as risk factors for poor prognosis in HCC patients (P<0.05). Conclusion The texture parameters of portal vein metastasis and enhanced CT, including skewness, energy, entropy and average value, have been identified as potential prognostic predictors for poor prognosis in HCC patients after TACE treatment. It is essential to consider these indicators before treatment and take appropriate measures to improve patient prognosis.

Key words: Hepatocellular carcinoma, Enhanced CT, Interventional therapy, Texture parameter, Efficacy evaluation

杨菁菁, 李莎, 蔡明月. 增强CT纹理参数在HBV相关肝细胞癌介入治疗效果评估中的应用[J]. 肝脏, 2024, 29(5): 534-537.

YANG Jing-jing, LI Sha, CAI Ming-yue. Application of enhanced CT texture parameters in evaluation of efficacy after interventional therapy for Hepatitis B associated hepatocellular carcinoma[J]. Chinese Hepatolgy, 2024, 29(5): 534-537.

/ 推荐

参考文献

[1] Chiara R, Gian PC, Angelo A, et al. Performance of cytokeratin-18 apoptotic fragment for the identification of hepatic fibrosis and inflammation in patients with chronic viral hepatitis: a meta-analysis[J]. Minerva Biotecnologica,2020,32(4):188-194.
[2] Carissimi F, Barbaglia MN, Salmi L, et al. Finding the seed of recurrence: Hepatocellular carcinoma circulating tumor cells and their potential to drive the surgical treatment[J]. World J Gastrointest Surg,2021,13(9):967-978.
[3] Zheng L, Li HL, Huang JH, et al. Serum midkine levels for the diagnosis and assessment of response to interventional therapy in patients with hepatocellular carcinoma[J]. J Intervent Med,2021,4(1):39-45.
[4] Guo L, Wei XB, Feng S, et al. Radiotherapy prior to or after transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus: a randomized controlled trial[J]. Hepatol Int,2022,16(6):1368-1378.
[5] Zhang H, Wang HC, Chai RP, et al. Application of Enhanced CT and Enhanced MRI Fusion Image in the Treatment of Primary Liver Cancer[J]. J Med Imaging Health Informatics,2020,10(8):1926-1932.
[6] Luo CL, Song YM, Liu YY, et al. Analysis of the value of enhanced CT combined with texture analysis in the differential diagnosis of pulmonary sclerosing pneumocytoma and atypical peripheral lung cancer: a feasibility study[J]. BMC Med Imaging,2022,22(1):16-16.
[7] 施婷婷, 李辉, 季长风, 等. 增强CT纹理分析在术前预测结肠癌分化程度中的应用价值[J]. 实用放射学杂志,2021,37(9):1480-1483.
[8] 中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作专业委员会, 中华医学会肝病学分会肝癌学组. 原发性肝癌规范化诊治的专家共识[J]. 临床肝胆病杂志,2009,25(2):83-92.
[9] Friendlander AH, Ettinger R L. Karnolsky performance statusseale[J]. Spec Care Dentist,2009,29(4):147-148.
[10] Schiavon G, Ruggiero A, Sleijfer S, et al. Tumor volumes measrement (3D) versus Response Evaluation Criteria in Solid Tumors (RECIST version 1.1, 1D) and Choi criteria (C) in assessing response of gastrointestinal stromal tumors (GIST) to imatinib (IM)[J]. J Clin Oncol,2011,29(15):10059.
[11] 周莉, 郭洁, 刘钰佩, 等. 慢性丙型肝炎病毒感染患者获得持续病毒学应答后肝细胞癌发生的危险因素[J]. 中华传染病杂志,2022,40(10):607-612.
[12] 赵首捷, 杜锡林, 杨振宇, 等. 微波消融辅助肝切除联合术后TACE治疗BCLC-B期肝细胞癌临床疗效分析[J]. 中国普通外科杂志,2020,29(7):812-819.
[13] 司贮元, 朱化强, 高恒军, 等. 超声与CT引导下射频消融治疗早期肝细胞癌效果比较[J]. 中华肝胆外科杂志,2020,26(6):417-421.
[14] 姜婷婷, 牟培源, 段伟宏, 等. TACE联合超声引导经皮微波消融治疗术后复发性肝细胞癌的临床研究[J]. 暨南大学学报(自然科学与医学版),2022,43(3):284-292.
[15] 张帅, 朱佳, 吴相柏, 等. 肝癌组织LncRNA TINCR和ANRIL表达水平及其与患者预后的关系[J]. 热带医学杂志,2019,19(1):55-59.
[16] 郑小敏, 曹锋, 钱立庭, 等. 定量CT身体组分分析预测肝细胞癌经导管动脉化疗栓塞术治疗预后的研究[J]. 中华放射学杂志,2021,55(4):371-376.
[17] 程申濠, 史红媛, 徐青, 等. 增强CT联合纹理分析对于胰腺导管内乳头状黏液性肿瘤恶性潜能的预测价值[J]. 中国临床医学影像杂志,2021,32(1):23-28.
[18] 徐学清, 李炳超, 冯铠莉. CT增强纹理技术对TACE治疗的原发性肝癌患者术后肿瘤短期进展的预测价值[J]. 实用肝脏病杂志,2020,23(3):423-426.
[19] 岑永义, 农海洋, 李传, 等. 基于CT增强扫描动脉期图像的纹理分析在肝细胞癌病理分化程度预测中的价值研究[J]. 临床放射学杂志,2022,41(8):1476-1481.