Department of Radiology, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Department of Anesthesia, Tumor Hospital, Guangxi Medical University, No. 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Clin Imaging. 2021 Jul;75:143-149. doi: 10.1016/j.clinimag.2021.01.022. Epub 2021 Jan 20.
Peritumoral edema is an independent prognostic risk factor for malignant tumors. Therefore, assessment of peritumoral edema in preoperative magnetic resonance imaging (MRI) may provide better prognostic information in patients with hepatocellular carcinoma (HCC).
To determine whether peritumoral edema in preoperative MRI is a prognostic factor for HCC.
A retrospective analysis of 90 patients with HCC confirmed by surgical pathology was performed. All patients' peritumoral edema in preoperative MRI was reviewed by two radiologists. The association of disease recurrence with peritumoral edema and clinicopathological features was assessed using the Cox proportional hazards model. Interobserver agreement for evaluating peritumoral edema was determined using Cohen's κ coefficient.
Recurrence and non-recurrence after an average 20.8 month follow-up was 25.6% (23/90) and 74.4% (67/90), respectively. The ratio of peritumoral edema of 90 patients with HCC in preoperative MRI was 35.6% (32/90). In univariate Cox regression analysis, peritumoral edema [hazard ratio (HR) 11.08, P < 0.001], tumor diameter (HR 4.12, P = 0.001), microvascular invasion (HR 2.78, P = 0.020), gender (HR 0.29, P = 0.006), cirrhosis (HR 2.45, P = 0.049), ascites syndrome (HR 2.83, P = 0.022), aspartate aminotransferase(AST)/alanine aminotransferase(ALT) (HR 5.07, P = 0.003) were indicators for HCC recurrence. In multivariate Cox regression analysis, the tumor diameter (HR 2.53, P = 0.032) and peritumoral edema (HR 8.71, P < 0.001) were independent prognostic factors of HCC. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral edema and tumor diameter were 82.6%&60.9%, 80.6%&77.6%, 59.4%&48.3%, and 93.1%&85.3%, respectively.
Peritumoral edema in preoperative MRI may be considered as a biomarker of prognostic information for patients with HCC.
瘤周水肿是恶性肿瘤的独立预后危险因素。因此，术前磁共振成像（MRI）评估瘤周水肿可为肝细胞癌（HCC）患者提供更好的预后信息。
确定术前 MRI 中的瘤周水肿是否为 HCC 的预后因素。
对经手术病理证实的 90 例 HCC 患者进行回顾性分析。由两位放射科医生对所有患者术前 MRI 中的瘤周水肿进行了评估。采用Cox 比例风险模型评估疾病复发与瘤周水肿及临床病理特征的关系。采用 Cohen's κ 系数评估评估瘤周水肿的观察者间一致性。
平均 20.8 个月的随访后，25.6%（23/90）患者出现复发，74.4%（67/90）患者无复发。90 例 HCC 患者术前 MRI 中瘤周水肿的比例为 35.6%（32/90）。单因素 Cox 回归分析显示，瘤周水肿[风险比（HR）11.08，P<0.001]、肿瘤直径（HR 4.12，P=0.001）、微血管侵犯（HR 2.78，P=0.020）、性别（HR 0.29，P=0.006）、肝硬化（HR 2.45，P=0.049）、腹水综合征（HR 2.83，P=0.022）、天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）（HR 5.07，P=0.003）是 HCC 复发的指标。多因素 Cox 回归分析显示，肿瘤直径（HR 2.53，P=0.032）和瘤周水肿（HR 8.71，P<0.001）是 HCC 的独立预后因素。瘤周水肿和肿瘤直径的灵敏度、特异度、阳性预测值和阴性预测值分别为 82.6%&60.9%、80.6%&77.6%、59.4%&48.3%和 93.1%&85.3%。
术前 MRI 中的瘤周水肿可作为 HCC 患者预后信息的生物标志物。
