Zhang Wei, Chen Jie, Liu Lijuan, Wang Lili, Liu Junjie, Su Danke
Department of Radiology.
Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China.
Onco Targets Ther. 2019 May 16;12:3791-3804. doi: 10.2147/OTT.S199136. eCollection 2019.
Preoperative treatments are considered for patients with worse outcome to improve overall survival and reduce tumor relapse. This study developed a prognostic risk estimation for patients with hepatitis B virus (HBV)-related solitary hepatocellular carcinoma after curative resection, including preoperative computed tomography (CT) signatures. Preoperative multiphasic CTs for 166 patients with operable HCC were performed in our hospital from 15 November 2013 through 15 May 2015. Follow-up information, until 5 June 2017, included: CT, pathological and clinical characteristics, and recurrence and metastases of HCC confirmed by pathological or radiological diagnosis. The parameters were analyzed by the Kaplan-Meier method and Cox proportional hazards regression analysis. In multivariate analyses, overall survival was not significantly associated with any of the analyzed prognostic risk factors, but did show that the following were significant prognostic risk factors for disease-free survival: larger tumor size, positive radiogenomic venous invasion, non-smooth tumor margin, and histological microvascular invasion. These were all incorporated into the nomogram. The calibration curves for predicting the probability of disease-free survival between the nomogram and actual observation showed good conformity. In patients with HBV-related HCC, CT signatures were a noninvasive significant indicator of disease-free survival. Thus, consideration of CT signatures may optimize preoperative treatment strategies for the individual patient.
对于预后较差的患者，会考虑进行术前治疗以提高总生存率并减少肿瘤复发。本研究针对乙型肝炎病毒（HBV）相关的孤立性肝细胞癌患者在根治性切除术后开发了一种预后风险评估方法，其中包括术前计算机断层扫描（CT）特征。2013年11月15日至2015年5月15日期间，我院对166例可手术切除的肝癌患者进行了术前多期CT检查。随访信息截至2017年6月5日，包括：CT、病理和临床特征，以及经病理或影像学诊断确诊的肝癌复发和转移情况。采用Kaplan-Meier法和Cox比例风险回归分析对参数进行分析。在多变量分析中，总生存率与任何分析的预后风险因素均无显著相关性，但显示以下因素是无病生存的显著预后风险因素：肿瘤体积较大、放射性基因组静脉侵犯阳性、肿瘤边缘不光滑以及组织学微血管侵犯。这些因素均被纳入列线图。列线图预测无病生存概率与实际观察结果之间的校准曲线显示出良好的一致性。在HBV相关肝癌患者中，CT特征是无病生存的非侵入性显著指标。因此，考虑CT特征可能会优化针对个体患者的术前治疗策略。
