Chen Yanling, Lu Qing, Zhu Yuli, Huang Beijian, Dong Yi, Wang Wenping
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Ultrasound Medicine and Engineering, Fudan University, Shanghai, China.
Ultrasound Med Biol. 2022 Jul;48(7):1190-1201. doi: 10.1016/j.ultrasmedbio.2022.02.014. Epub 2022 Apr 6.
The goal of the study described here was to define the predictive value of pre-operative clinical information and contrast-enhanced ultrasound (CEUS) imaging characteristics in combined hepatocellular-cholangiocarcinoma (CHC) patients with microvascular invasion (MVI). Seventy-six patients with pathologically confirmed CHC were enrolled in this study, comprising 18 patients with MVI-positive status and 58 with MVI-negative CHC nodules. The pre-operative clinical data and CEUS imaging features were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the potential predictors of MVI in CHC. Recurrence-free survival (RFS) after hepatectomy was compared between patients with different MVI status using the log-rank test and Kaplan-Meier survival curves. Univariate analysis indicated that the following parameters of patients with CHC significantly differed between the MVI-positive and MVI-negative groups (p<0.05): tumor size, α-fetoprotein ≥400 ng/mL, enhancement patterns in arterial phase and marked washout during the portal venous phase on CEUS. On multivariate logistic regression analysis, only the CEUS characteristics of heterogeneous enhancement (odds ratio = 6.807; 95% confidence interval [CI]: 1.099, 42.147; p = 0.039) and marked washout (odds ratio = 4.380; 95% CI: 1.050,18.270; p = 0.043) were identified as independent predictors of MVI in CHC. The combination of the two risk factors in predicting MVI achieved a better diagnostic performance than each parameter alone, with an area under the receiver operating characteristic curve of 0.736 (0.622, 0.830). After hepatectomy, CHC patients with MVI exhibited earlier recurrence compared with those without MVI (hazard ratio = 1.859; 95% CI: 0.8699-3.9722, p = 0.046). The CEUS imaging features of heterogeneous enhancement in the arterial phase and marked washout during the portal venous phase were the potential predictors of MVI in CHC. Aside from that, CHC patients with MVI had an earlier recurrence rate than those without MVI after surgery.
本研究的目的是确定术前临床信息和超声造影（CEUS）成像特征在合并微血管侵犯（MVI）的肝细胞-胆管癌（CHC）患者中的预测价值。本研究纳入了76例经病理证实的CHC患者，其中18例MVI阳性，58例MVI阴性CHC结节。对术前临床资料和CEUS成像特征进行回顾性分析。进行单因素和多因素分析以确定CHC中MVI的潜在预测因素。采用对数秩检验和Kaplan-Meier生存曲线比较不同MVI状态患者肝切除术后的无复发生存期（RFS）。单因素分析表明，CHC患者的以下参数在MVI阳性组和MVI阴性组之间存在显著差异（p<0.05）：肿瘤大小、甲胎蛋白≥400 ng/mL、动脉期增强模式以及CEUS门静脉期明显廓清。多因素logistic回归分析显示，仅CEUS的不均匀增强特征（比值比=6.807；95%置信区间[CI]：1.099，42.147；p=0.039）和明显廓清（比值比=4.380；95%CI：1.050，18.270；p=0.043）被确定为CHC中MVI的独立预测因素。这两个危险因素联合预测MVI的诊断性能优于单独的每个参数，受试者工作特征曲线下面积为0.736（0.622，0.830）。肝切除术后，MVI阳性的CHC患者比MVI阴性患者复发更早（风险比=1.859；95%CI：0.8699-3.9722，p=0.046）。动脉期不均匀增强和门静脉期明显廓清的CEUS成像特征是CHC中MVI的潜在预测因素。除此之外，MVI阳性的CHC患者术后复发率比MVI阴性患者更早。
