Tian HaiYing, Chen Yuling, Li XiaoHai, Zhao LiNa, Li Sha, Liao ChunYan, Wu YeTing, Zhang Bei
Clinical Medical College, Guizhou Medical University, Guiyang, Guizhou, 550004, People's Republic of China.
Department of Ultrasound Medicine, Guizhou Provincial People's Hospital, Guiyang, Guizhou, 550002, People's Republic of China.
J Cancer. 2024 Apr 23;15(11):3362-3369. doi: 10.7150/jca.94550. eCollection 2024.
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are primary liver cancers with different therapeutic methods and prognoses. This study aims to investigate the ultrasonography and enhanced computed tomography (CT) features of these cancers and improve the early diagnosis rate. We retrospectively analyzed the clinical and imaging data of 319 patients diagnosed with HCC and 124 patients diagnosed with ICC, confirmed by pathology. A total of 443 patients were eligible in this study. From the perspective of clinical data, between HCC and ICC patients existed significant differences in age, gender, hepatic background, serum tumor markers of AFP and CA19.9, chronic hepatitis B/C and lymph node infiltration (p<0.05), but not in tumor size, microvascular invasion, serum tumor markers of CEA and CA125 (P>0.05). With respect to ultrasonography features, HCC patients had a higher proportion than ICC patients in splenomegaly (p=0.001), while ICC patients had a higher proportion than HCC patients in absence/not rich vascularity and intrahepatic bile duct dilatation (p<0.05). With respect to CT features, HCC patients were significantly different from ICC patients in the three-phase enhanced CT value mean, enhanced intensity and homogeneity of nodules (P<0.05). A multivariate logistic regression analysis was performed to further clarify the correlation of these indices. However, only age≤60 years (OR=1.861, P=0.045), male (OR=3.850, P<0.001), AFP>7ng/ml (OR=0.119, P<0.001), lymph node infiltration (OR=5.968, P<0.001), intrahepatic bile duct dilatation (OR=2.414, P=0.04), splenomegaly (OR=0.081, P<0.001), rim APHE (OR=3.109, P=0.002), and iso- or hyper enhancement (OR=0.188, P<0.001) were independent risk factors. While there are overlapping ultrasonography and CT features between HCC and ICC, the integration of tumor markers and specific imaging characteristics can be beneficial in distinguishing between the two.
肝细胞癌（HCC）和肝内胆管癌（ICC）是具有不同治疗方法和预后的原发性肝癌。本研究旨在探讨这些癌症的超声检查和增强计算机断层扫描（CT）特征，并提高早期诊断率。我们回顾性分析了319例经病理确诊为HCC的患者和124例经病理确诊为ICC的患者的临床和影像资料。本研究共纳入443例患者。从临床资料来看，HCC患者和ICC患者在年龄、性别、肝脏背景、血清肿瘤标志物甲胎蛋白（AFP）和糖类抗原19-9（CA19.9）、慢性乙型/丙型肝炎及淋巴结浸润方面存在显著差异（p<0.05），但在肿瘤大小、微血管侵犯、血清肿瘤标志物癌胚抗原（CEA）和糖类抗原125（CA125）方面无显著差异（P>0.05）。关于超声特征，HCC患者脾肿大的比例高于ICC患者（p=0.001），而ICC患者血管不丰富/缺乏及肝内胆管扩张的比例高于HCC患者（p<0.05）。关于CT特征，HCC患者与ICC患者在CT三相增强值均值、结节增强强度及均匀性方面存在显著差异（P<0.05）。进行多因素逻辑回归分析以进一步阐明这些指标的相关性。然而，只有年龄≤60岁（OR=1.861，P=0.045）、男性（OR=3.850，P<0.001）、AFP>7ng/ml（OR=0.119，P<0.001）、淋巴结浸润（OR=5.968，P<0.001）、肝内胆管扩张（OR=2.414，P=0.04）、脾肿大（OR=0.081，P<0.001）、边缘动脉期高密度强化（OR=3.109，P=0.002）及等密度或高密度强化（OR=0.188，P<0.001）是独立危险因素。虽然HCC和ICC之间存在重叠的超声和CT特征，但整合肿瘤标志物和特定影像特征有助于区分两者。
