术前影像学评分联合肿瘤标志物对肝细胞癌TACE术后预后评估价值的研究

doi:10.7517/issn.1674-0475.230712

摘要/Abstract

摘要： 探讨术前影像学肿瘤负荷评分（TBS）联合血清甲胎蛋白（AFP）对肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）术后预后评估价值。收集87名接受TACE手术的HCC患者的临床及影像资料，根据CT增强影像计算TBS评分。使用Kaplan-Meier生存曲线和对数秩检验进行组间总生存期（OS）比较。结果显示，HCC患者TACE术后中位生存期为20.5个月，平均TBS评分为9.52±3.26。3年OS随着TBS的升高而逐渐降低（P<0.001）；TBS≤9.9和TBS>9.9患者间OS差异有统计学意义（P<0.001）。患者TACE术前AFP水平与OS呈中等程度负相关（r=-0.519；P<0.001），与AFP<400 ng/mL的患者相比，AFP≥400 ng/mL患者的OS更差（P=0.001）。多因素分析显示TBS≤9.9且AFP≥400 ng/mL （HR：5.449；95% CI：1.951~15.217；P=0.01）、TBS>9.9且AFP<400 ng/mL （HR：13.576；95% CI：5.873~31.382；P<0.001）和TBS>9.9且AFP≥400 ng/mL （HR：27.854；95% CI：8.950~86.683；P<0.001）均是肝细胞癌患者TACE术后OS的独立预测因素，且TBS≤9.9且AFP<400 ng/mL患者的OS好于其他三组（P<0.05）。因此，基于影像学的TBS评分结合AFP水平对进行TACE的HCC患者预后评估具有较高的价值。

关键词: 肝细胞癌, 经动脉化疗栓塞术, 肿瘤负荷评分, 甲胎蛋白

Abstract: To evaluate the value of imaging tumor burden score (TBS) combined with serum alpha-fetoprotein (AFP) in the prognosis of hepatocellular carcinoma (HCC) after transarterial chemo-embolization (TACE). Clinical and imaging data of 87 HCC patients who underwent TACE were collected. The TBS scores were calculated from CT-enhanced images. OS was compared between groups using Kaplan-Meier survival curves and log-rank test. The median survival of HCC patients after TACE was 20.5 months, and the mean TBS score was 9.52±3.26. The results showed that the 3-year OS decreased progressively with increasing TBS (P<0.001); the difference in OS between patients with TBS ≤ 9.9 and TBS>9.9 was statistically significant (P<0.001). Patients' pre-TACE AFP levels were moderately negatively correlated with OS (r=-0.519; P<0.001), and OS was worse in patients with AFP ≥ 400 ng/mL compared with those with AFP < 400 ng/mL (P=0.001). Multifactorial analysis showed that patients with TBS ≤ 9.9 and AFP ≥ 400 ng/mL (HR:5.449; 95%CI:1.951-15.217; P=0.01), TBS>9.9 and AFP<400 ng/mL (HR:13.576; 95%CI:5.873-31.382; P<0.001) and TBS>9.9 and AFP ≥ 400 ng/mL (HR:27.854; 95%CI:8.950-86.683; P<0.001) were both independent predictors of OS after TACE in patients with hepatocellular carcinoma, and the OS of patients with TBS ≤ 9.9 and AFP<400 ng/mL was better than the other three groups (P<0.05). Therefore, the image-based TBS score combined with AFP level has a high value in the prognosis assessment of HCC patients with TACE.

Key words: hepatocellular carcinoma, transarterial chemo-embolization, tumor burden score, alpha-fetoprotein

夏志颖, 杜福川. 术前影像学评分联合肿瘤标志物对肝细胞癌TACE术后预后评估价值的研究[J]. 影像科学与光化学, 2023, 41(6): 320-325.

XIA Zhiying, DU Fuchuan. Preoperative Imaging Score Combined with Tumor Marker to Evaluate the Prognosis of Hepatocellular Carcinoma after TACE[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(6): 320-325.

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