治疗初治的肝细胞癌患者行局部区域治疗前常规使用胸部 CT 分期：有必要吗？

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.

Ann Acad Med Singap. 2017 Jul;46(7):282-286.

INTRODUCTION

The lung is the most common site of distal metastasis in patients with hepatocellular carcinoma (HCC), as seen in more than half of patients with extrahepatic disease. The incidence of pulmonary metastasis in all patients with HCC, however, remains low (between 4.5% to 20%). Their presence, nevertheless, contraindicates curative locoregional therapies. The role of staging chest computed tomography (CT) before locoregional treatment is not well defined. This study aimed to assess the utility of pre-treatment chest CT prior to locoregional therapy.

MATERIALS AND METHODS

Retrospective review of continuous cases of treatment-naïve HCC referred for locoregional therapy from 2004 to 2013 was performed. Patients with pre-treatment chest CT were evaluated for the presence of pulmonary metastases. HCC features (size, numbers, vascular invasion, nodal status and bone metastases) were recorded. Univariate analysis and multivariate logistic regression were performed for significant association.

RESULTS

A total of 780 patients were reviewed, of which 135 received staging chest CT. Pulmonary metastases (n = 17, 12.6%), benign lesions (n = 41, 30.4%) and indeterminate lesions (n = 11, 8.1%) were detected. Among the indeterminate lesions, there were losses to follow-up (n = 2) and deaths within the study period (n = 3). All patients with pulmonary metastases were declined locoregional therapy. Univariate analysis showed statistical significant association between pulmonary metastases with the number of intrahepatic lesions ( <0.01), primary tumour size ( = 0.018) and presence of vascular invasion ( <0.01). On multivariate analysis, the number of intrahepatic lesions (OR: 9.7; 95% CI, 1.6 to 57.2; = 0.012) and presence of both hepatic and portal venous invasions (OR: 11.8; 95% CI, 1.1 to 128.8; = 0.043) were the 2 independent positive predictors of pulmonary metastases.

CONCLUSION

The prevalence of pulmonary metastasis is low in HCC and our study does not support the routine use of staging chest CT in all treatment-naïve patients. It can, however, be considered in cases with multiple lesions or vascular invasion.

介绍

在肝细胞癌（HCC）患者中，肺是远处转移最常见的部位，超过一半的肝外疾病患者可见。然而，所有 HCC 患者的肺转移发生率仍然较低（4.5%至 20%之间）。然而，它们的存在却排除了根治性局部治疗的可能性。局部治疗前分期胸部 CT 的作用尚未明确。本研究旨在评估局部治疗前治疗前胸部 CT 的效用。

材料和方法

对 2004 年至 2013 年连续接受局部治疗的初治 HCC 患者进行回顾性分析。评估了接受治疗前胸部 CT 的患者是否存在肺转移。记录了 HCC 的特征（大小、数量、血管侵犯、淋巴结状态和骨转移）。对有意义的关联进行了单变量分析和多变量逻辑回归分析。

结果

共回顾了 780 例患者，其中 135 例接受了分期胸部 CT。检测到肺转移（n=17，12.6%）、良性病变（n=41，30.4%）和不确定病变（n=11，8.1%）。在不确定病变中，有 2 例失访，3 例在研究期间死亡。所有有肺转移的患者均被拒绝局部治疗。单变量分析显示，肺转移与肝内病变数量（<0.01）、原发肿瘤大小（=0.018）和血管侵犯存在（<0.01）之间存在统计学显著关联。多变量分析显示，肝内病变数量（OR：9.7；95%CI，1.6 至 57.2；=0.012）和肝门静脉同时侵犯（OR：11.8；95%CI，1.1 至 128.8；=0.043）是肺转移的 2 个独立阳性预测因素。