基于磁共振弹性成像的肝细胞癌根治性切除术后复发预测。
Magnetic resonance elastography-based prediction of hepatocellular carcinoma recurrence after curative resection.
机构信息
Departments of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Departments of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
出版信息
Surgery. 2021 Jul;170(1):167-172. doi: 10.1016/j.surg.2021.02.027. Epub 2021 Mar 19.
BACKGROUND
Liver stiffness measurement using magnetic resonance elastography can assess the severity of liver fibrosis, which is significantly associated with recurrence after curative resection for hepatocellular carcinoma. The aim of this prospective study was to investigate whether preoperative liver stiffness measurement by magnetic resonance elastograhy can predict recurrence after curative resection for hepatocellular carcinoma.
METHODS
Patients who underwent preoperative liver stiffness measurement and curative resection for hepatocellular carcinoma were enrolled in this study. Potential associations between liver stiffness measurement, along with other clinical and pathologic variables, and intrahepatic hepatocellular carcinoma recurrence were analyzed.
RESULTS
In total, 156 patients were included in this study. During a median follow-up period of 25.1 months (range, 6.0-60.5 months), 72 (46.1%) patients with hepatocellular carcinoma had an intrahepatic recurrence. The median disease-free period after resection was 17.9 months (range, 1.0-60.5 months). In the multivariate analysis, liver stiffness measurement (hazard ratio, 1.27; 95% confidence interval, 1.11-1.43; P <.001) and vascular invasion (hazard ratio, 1.96; 95% confidence interval, 1.15-3.25; P = .013) were identified as independent predictors of recurrence. When the optimal cutoff point was set at 4.53 kPa using the minimal P value approach, the disease-free period after curative resection in 71 patients with a liver stiffness measurement value ≥4.53 kPa (11.3 months [range, 2.0-60.5 months]) was significantly shorter than that of 85 patients with a liver stiffness measurement value <4.53 kPa (22.5 months [range, 1.1-60.5 months]; P <.001).
CONCLUSION
Liver stiffness measurement using magnetic resonance elastography is a useful preoperative predictor of intrahepatic recurrence after curative resection for hepatocellular carcinoma.
背景
磁共振弹性成像技术可以测量肝脏硬度，从而评估肝纤维化的严重程度，而肝纤维化与肝癌根治性切除术后的复发显著相关。本前瞻性研究旨在探讨术前磁共振弹性成像测量的肝脏硬度能否预测肝癌根治性切除术后的复发。
方法
本研究纳入了接受术前肝脏硬度测量和肝癌根治性切除术的患者。分析了肝脏硬度测量值与其他临床和病理变量之间与肝内肝癌复发的潜在关联。
结果
本研究共纳入 156 例患者。中位随访时间为 25.1 个月（范围为 6.0-60.5 个月），72 例（46.1%）肝癌患者出现肝内复发。术后无疾病生存期为 17.9 个月（范围为 1.0-60.5 个月）。多变量分析显示，肝脏硬度测量值（风险比，1.27；95%置信区间，1.11-1.43；P<0.001）和血管侵犯（风险比，1.96；95%置信区间，1.15-3.25；P=0.013）是复发的独立预测因素。当采用最小 P 值法将最佳截断点设定为 4.53 kPa 时，71 例肝脏硬度测量值≥4.53 kPa（11.3 个月[范围，2.0-60.5 个月]）患者的根治性切除术后无疾病生存时间明显短于 85 例肝脏硬度测量值<4.53 kPa（22.5 个月[范围，1.1-60.5 个月]）患者（P<0.001）。
结论
磁共振弹性成像技术测量肝脏硬度是肝癌根治性切除术后肝内复发的有用术前预测指标。
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