Muhi Ali, Ichikawa Tomoaki, Motosugi Utaroh, Sano Katsuhiro, Fatima Zareen, Matsuda Masanori, Fujii Hideki, Enomoto Nobuyuki, Araki Tsutomu
Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
First Department of Surgery, University of Yamanashi, Yamanashi, Japan.
Hepatol Int. 2013 Jun;7(2):662-8. doi: 10.1007/s12072-012-9383-2. Epub 2012 Jun 22.
The effectiveness of imaging (including apparent diffusion coefficient [ADC] of diffusion-weighted magnetic resonance imaging [DWI]) and laboratory variables for predicting early tumor recurrence and overall survival after surgery in hepatocellular carcinoma (HCC) patients are analyzed.
The present study included 116 consecutive patients with HCC who underwent partial hepatectomy. Patients were classified into two groups: patients with and without early recurrence (<1 year). Preoperative imaging variables (tumor number, size, shape, capsule, ADC, and venous invasion) and laboratory variables were evaluated to predict early recurrence using univariate and multivariate analyses. Overall survival was calculated using the Kaplan-Meier method.
Twenty patients (17 %) developed early recurrence after surgery. Multivariate logistic regression analysis showed that tumor ADC (p = 0.0002), aspartate aminotransferase (p = 0.0121), and serum prothrombin time activity percentage (p = 0.0082) were statistically significant for predicting early recurrence. The optimal ADC cutoff value for predicting early recurrence obtained from receiver operating characteristic analysis was ≤0.898 × 10(-3) mm(2)/s. In patients with ADC ≤0.898 × 10(-3) mm(2)/s, the 3- and 5-year survival rates (77 and 56 %, respectively) were significantly decreased compared with those in patients with ADC >0.898 × 10(-3) mm(2)/s (97 and 97 %, respectively; p = 0.0015).
Low tumor ADC value by DWI was a risk factor for early postoperative HCC recurrence and was associated with lower patient survival rates.
分析影像学检查（包括弥散加权磁共振成像[DWI]的表观扩散系数[ADC]）及实验室指标对预测肝细胞癌（HCC）患者术后早期肿瘤复发及总生存期的有效性。
本研究纳入116例连续接受肝部分切除术的HCC患者。患者被分为两组：有早期复发（<1年）和无早期复发的患者。采用单因素和多因素分析评估术前影像学指标（肿瘤数量、大小、形态、包膜、ADC及静脉侵犯）及实验室指标以预测早期复发。采用Kaplan-Meier法计算总生存期。
20例患者（17%）术后出现早期复发。多因素logistic回归分析显示，肿瘤ADC（p = 0.0002）、天冬氨酸转氨酶（p = 0.0121）及血清凝血酶原时间活动度百分比（p = 0.0082）对预测早期复发具有统计学意义。通过受试者工作特征分析得出的预测早期复发的最佳ADC临界值为≤0.898×10(-3) mm(2)/s。ADC≤0.898×10(-3) mm(2)/s的患者，其3年和5年生存率（分别为77%和56%）与ADC>0.898×10(-3) mm(2)/s的患者（分别为97%和97%；p = 0.0015）相比显著降低。
DWI显示肿瘤ADC值低是HCC术后早期复发的危险因素，且与患者较低的生存率相关。
