Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow G31 2ER, UK.
Tomography. 2024 Feb 28;10(3):349-359. doi: 10.3390/tomography10030027.
The prognostic value of CT-derived liver volume in terms of cancer outcomes is not clear. The aim of the present study was to examine the relationship between liver area on a single axial CT-slice and the total liver volume in patients with colonic cancer. Furthermore, we examine the relationship between liver volume, determined using this novel method, clinicopathological variables and survival.
Consecutive patients who underwent potentially curative surgery for colonic cancer were identified from a prospectively maintained database. Maximal liver area on axial CT-slice (cm) and total volume (cm), were obtained by the manual segmentation of pre-operative CT-images in a PACS viewer. The maximal liver area was normalized for body height to create the liver index (LI) and values, categorized into tertiles. The primary outcome of interest was overall survival (OS). Relationships between LI and clinico-pathological variables were examined using chi-square analysis and binary logistic regression. The relationship between LI and OS was examined using cox proportional hazard regression.
A total of 359 patients were included. A total of 51% ( = 182) of patients were male and 73% ( = 261) were aged 65 years or older. 81% ( = 305) of patients were alive 3-years post-operatively. The median maximal liver area on the axial CT slice was 178.7 (163.7-198.4) cm. The median total liver volume was 1509.13 (857.8-3337.1) cm. Maximal liver area strongly correlated with total liver volume (R = 0.749). The median LI was 66.8 (62.0-71.6) cm/m. On multivariate analysis, age ( < 0.001), sex ( < 0.05), BMI ( < 0.001) and T2DM ( < 0.05) remained significantly associated with LI. On univariate analysis, neither LI (continuous) or LI (tertiles) were significantly associated with OS ( = 0.582 and = 0.290, respectively).
The simple, reliable method proposed in this study for quantifying liver volume using CT-imaging was found to have an excellent correlation between observers and provided results consistent with the contemporary literature. This method may facilitate the further examination of liver volume in future cancer studies.
CT 衍生的肝体积在癌症预后方面的预测价值尚不清楚。本研究的目的是检查结肠癌患者的单次轴位 CT 切片上的肝区与总肝体积之间的关系。此外，我们还检查了使用这种新方法确定的肝体积与临床病理变量和生存之间的关系。
从一个前瞻性维护的数据库中确定接受结肠癌根治性手术的连续患者。在 PACS 查看器中手动分割术前 CT 图像以获得轴位 CT 切片上的最大肝区（cm）和总体积（cm）。通过对身体高度进行归一化，创建肝指数（LI）并将值分为三部分。主要研究终点是总生存期（OS）。使用卡方分析和二元逻辑回归检查 LI 与临床病理变量之间的关系。使用 cox 比例风险回归检查 LI 与 OS 的关系。
共纳入 359 例患者。51%（=182）的患者为男性，73%（=261）的患者年龄为 65 岁或以上。81%（=305）的患者术后 3 年存活。轴位 CT 切片上最大肝区的中位数为 178.7（163.7-198.4）cm。总肝体积中位数为 1509.13（857.8-3337.1）cm。最大肝区与总肝体积具有很强的相关性（R = 0.749）。中位数 LI 为 66.8（62.0-71.6）cm/m。多变量分析显示，年龄（<0.001）、性别（<0.05）、BMI（<0.001）和 T2DM（<0.05）与 LI 仍显著相关。在单变量分析中，LI（连续）或 LI（三分位数）均与 OS 无显著相关性（=0.582 和=0.290）。
本研究提出的使用 CT 成像量化肝体积的简单、可靠方法在观察者之间具有极好的相关性，并提供了与当代文献一致的结果。这种方法可能有助于在未来的癌症研究中进一步检查肝体积。
