经动脉内对比增强超声预测肝癌经载药微球动脉化疗栓塞术的短期肿瘤反应。

Intraarterial contrast-enhanced ultrasound to predict the short-term tumour response of hepatocellular carcinoma to Transarterial chemoembolization with Lipiodol.

机构信息

Department of ultrasound, The First Medical Centre, Chinese PLA General Hospital, No. 28 of Fuxing Road, Haidian District, Beijing, 100853, China.

出版信息

BMC Cancer. 2021 Nov 2;21(1):1171. doi: 10.1186/s12885-021-08867-5.

BACKGROUND

Transarterial chemoembolization (TACE) is an effective locoregional therapy in hepatocellular carcinoma (HCC). However, it is difficult to predict the tumour response (TR) of TACE intraprocedurally. The aim of this study was to predict the TR after TACE (1-3 months) in HCC patients using intraprocedural intraarterial contrast enhanced ultrasound (IA-CEUS).

METHODS

In this case-control study, consecutive patients who received TACE in our hospital from September 2018 to May 2019 were enrolled. IA-CEUS was performed before and after TACE. Postoperative contrast-enhanced liver MRI was performed 1-3 months after TACE as the gold standard. According to the modified Response Evaluation Criteria in Solid Tumours (mRECIST), ultrasonic manifestations were compared between the complete remission (CR) group and non-CR group by univariate and multivariate analyses. A logistic predictive model was established and validated, and its diagnostic efficiency was evaluated.

RESULTS

Forty-four patients with sixty-one lesions were enrolled in the study. Multivariate analysis identified, the risk factors as a large lesion diameter (OR: 1.84; 95% confidence interval [CI]: 1.009, 3.080; P = 0.020), a larger dimension of non-enhancing area in superior mesenteric artery (SMA)-CEUS than the size in B-mode ultrasound preoperatively (OR: 3.379; 95% CI: 1.346,8.484; P = 0.010), presence of corona enhancement in hepatic artery (HA)-CEUS postoperatively (OR: 6.642; 95% CI: 1.214, 36.331; P = 0.029), and decreased corona enhancement thickness (per centimetre) postoperatively (OR: 0.025; 95% CI: 0.006,0.718; P = 0.025). The area under the receiver operating characteristic curve (AUROC) of the predictive model was 0.904 (95% CI: 0.804, 0.966; P < 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 81.08, 91.67, 85.25, 93.75, and 75.86%, respectively. Leave-one-out cross-validation (LOOCV) showed that the accuracy was 77.05%.

CONCLUSIONS

Intraprocedural IA-CEUS can be used to predict the TR in HCC patients after TACE.

背景

经动脉化疗栓塞术（TACE）是治疗肝细胞癌（HCC）的有效局部区域治疗方法。然而，术中很难预测 TACE 的肿瘤反应（TR）。本研究旨在使用术中经动脉对比增强超声（IA-CEUS）预测 HCC 患者 TACE 后（1-3 个月）的 TR。

方法

本病例对照研究纳入了 2018 年 9 月至 2019 年 5 月在我院接受 TACE 的连续患者。在 TACE 前后进行 IA-CEUS。TACE 后 1-3 个月行术后增强肝脏 MRI 作为金标准。根据改良实体瘤反应评价标准（mRECIST），通过单变量和多变量分析比较完全缓解（CR）组和非 CR 组的超声表现。建立并验证了逻辑预测模型，并评估了其诊断效率。

结果

本研究共纳入 44 例 61 个病灶患者。多变量分析确定，大病灶直径（OR：1.84；95%置信区间[CI]：1.009，3.080；P=0.020）、术前肠系膜上动脉（SMA）-CEUS 中非增强区尺寸大于 B 型超声（OR：3.379；95%CI：1.346，8.484；P=0.010）、术后肝动脉（HA）-CEUS 中出现 corona 增强（OR：6.642；95%CI：1.214，36.331；P=0.029）以及术后 corona 增强厚度（每厘米）降低（OR：0.025；95%CI：0.006，0.718；P=0.025）是预测因素。预测模型的受试者工作特征曲线下面积（AUROC）为 0.904（95%CI：0.804，0.966；P<0.001）。灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为 81.08%、91.67%、85.25%、93.75%和 75.86%。留一法交叉验证（LOOCV）显示准确率为 77.05%。