彩色多普勒超声血流参数对肝细胞癌患者术后早期复发的预测价值研究
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摘要
目的:分析术前彩色多普勒超声(CDFI)检测的血流动力学指标对肝细胞癌(HCC)患者术后早期复发的预测价值。方法:回顾性分析2015年6月至2016年12月在广西医科大学附属肿瘤医院行HCC切除术的125例HCC患者,所有患者术前均行实验室检查和CDFI检查;根据HCC术后1年内是否复发者定义为早期复发组(97例)和随访截止日期内无复发者定义为无复发组(28例);采用单因素和多因素Logistic回归分析方法分析预测HCC切除术后早期复发的相关因素。结果:两组年龄、肿瘤最大直径(≤5cm/>5cm)、是否有癌栓、血清AFP是否阳性、门静脉血流平均流速(V)、肝动脉搏动指数(PI)及肝动脉阻力指数(RI)比较,差异均有统计学意义(均P<0.05);多因素Logistic回归分析显示:术前血清AFP阳性(血清AFP水平>400μg/L)、有癌栓以及肝动脉PI、RI低是HCC患者术后早期复发的独立危险因素(均P<0.05)。结论:CDFI检测肝动脉的RI、PI对预测HCC患者术后早期复发具有较高的敏感性,有望成为HCC高危复发人群的有效筛查指标之一。
Objective:To analyze the value of hemodynamic indexes of color Doppler flow imaging(CDFI)in predicting postoperative recurrence of hepatocellular carcinoma(HCC).Methods:A total of 125 HCC patients treated in our hospital from June 2015 to December 2016 were recruited,and divided into early recurrence group(n=97)and non-recurrence group(n=28)according to whether postoperative recurrence of HCC occurred within one year.The risk factor influencing HCC recurrence was analyzed with univariate and multivariate analysis.Results:There were significant differences in the age,tumor diameter(≤5 cm/>5 cm),tumor thrombus,preoperative AFP level,portal vein velocity,pulsatility index(PI)and resistance index(RI)between the two groups(P<0.05).Multivariate analysis showed that preoperative AFP level,tumor thrombus,PI and RI of hepatic artery were independent risk factors for early recurrence after HCC resection.Conclusion:The RI and PI of hepatic artery detected by CDFI have high sensitivities for predicting early recurrence after resection of HCC,which are expected to be the effective screening indicators for HCC high-risk recurrence population.
Objective:To analyze the value of hemodynamic indexes of color Doppler flow imaging(CDFI)in predicting postoperative recurrence of hepatocellular carcinoma(HCC).Methods:A total of 125 HCC patients treated in our hospital from June 2015 to December 2016 were recruited,and divided into early recurrence group(n=97)and non-recurrence group(n=28)according to whether postoperative recurrence of HCC occurred within one year.The risk factor influencing HCC recurrence was analyzed with univariate and multivariate analysis.Results:There were significant differences in the age,tumor diameter(≤5 cm/>5 cm),tumor thrombus,preoperative AFP level,portal vein velocity,pulsatility index(PI)and resistance index(RI)between the two groups(P<0.05).Multivariate analysis showed that preoperative AFP level,tumor thrombus,PI and RI of hepatic artery were independent risk factors for early recurrence after HCC resection.Conclusion:The RI and PI of hepatic artery detected by CDFI have high sensitivities for predicting early recurrence after resection of HCC,which are expected to be the effective screening indicators for HCC high-risk recurrence population.
引文
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[2]HONG Y M,CHO M,YOON K T,et al.Risk factors of early recurrence after curative hepatectomy in hepatocellular carcinoma[J].Tumour Biol,2017,39(10):101-106.
[3]BERZIGOTTI A,REVERTER E,GARCIA-CRIADOA,et al.Reliability of the estimation of total hepatic blood flow by Doppler ultrasound in patients with cirrhotic portal hypertension[J].J Hepatol,2013,59(4):717-722.
[4]郑义兰,崔惠勤.不同影像学手段在甲胎蛋白阴性肝癌术后复发中的早期诊断价值[J].广西医科大学学报,2018,35(5):707-709.
[5]PORTOLANI N,CONIGLIO A,GHIDONI S,et al.Early and late recurrence after liver resection for hepatocellular carcinoma:prognostic and therapeutic implications[J].Ann Surg,2006,243(2):229-235.
[6]TABRIZIAN P,JIBARA G,SHRAGER B,et al.Recurrence of hepatocellular cancer after resection:patterns,treatments,and prognosis[J].Ann Surg,2015,261(5):947-955.
[7]KAMIYAMA T,KAKISAKA T,ORIMO T,et al.Hepatectomy for hepatocellular carcinoma with portal vein tumor thrombus[J].World J Hepatol,2017,9(36):1296-1304.
[8]许戈良.肝癌血流动力学改变及其意义[J].中华肝脏外科手术学电子杂志,2018,7(2):100-102.
[9]HSIEH M C,HSU H T,HSIAO P C,et al.Role of VEGF-C gene polymorphisms in susceptibility to hepatocellular carcinoma and its pathological development[J].J Clin Lab Anal,2014,28(3):237-244.
[10]李万湖,董帅,胡旭东,等.多层螺旋CT血管造影对原发性肝癌动静脉瘘和肝外供血动脉评估价值[J].中华肿瘤防治杂志,2017,24(11):755-758.