Lin Hsuan-Hwai, Peng Yi-Jen, Chang Chao-Feng, Chang Ping-Ying, Peng Ping-Chi, Chang Wei-Chou, Chen Teng-Wei, Hsieh Tsai-Yuan
Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
Division of Experimental Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan.
Am J Cancer Res. 2024 Jun 15;14(6):2984-2993. doi: 10.62347/MYNS2426. eCollection 2024.
This study aimed to define the role of heterogeneity of liver parenchymal enhancement on computed tomography (CT) in the survival of patients with hepatocellular carcinoma (HCC) after hepatic resection. The medical records of patients with HCCs and who had undergone hepatic resection were retrospectively reviewed. The standard deviation (SD) of three different enhanced CT scan images was used to estimate the heterogeneity of liver parenchymal enhancement: SD of > 5.6, heterogenous enhancement, and SD of ≤ 5.6, homogeneous enhancement. A total of 57 patients had heterogenous enhancement, and 143 patients had homogeneous enhancement. The patients with heterogenous enhancement had longer disease-free and overall survivals than those with other enhancements (log-rank test, < 0.001 and = 0.036). The pathologic exam showed that heterogenous enhancement tended to develop septa in the peritumoral liver tissues. The prevalence of CD8 cells was significantly higher in the peritumor liver tissues with septa than in those without (0.83% vs. 0.26%, < 0.001). The peritumoral CD8/Foxp3 ratio was higher in the liver tissues with septa than in those without (1.22 vs. 0.47, = 0.001), and patients with CD8/Foxp3 of > 0.8 had better overall survival than those with CD8/Foxp3 of ≤ 0.8 (log-rank test, = 0.028). In conclusion, patients who had undergone hepatic resection with a heterogenous liver parenchymal enhancement tended to develop hepatic septa, which was associated with a higher CD8/Foxp3 ratio and longer survival. Therefore, contrast-enhanced CT scans might be a useful tool to predict the outcome of HCC.
本研究旨在明确肝脏实质增强的异质性在计算机断层扫描（CT）上对肝细胞癌（HCC）患者肝切除术后生存的作用。对接受肝切除的HCC患者的病历进行回顾性分析。使用三种不同增强CT扫描图像的标准差（SD）来评估肝脏实质增强的异质性：SD>5.6为异质性增强，SD≤5.6为均匀性增强。共有57例患者为异质性增强，143例患者为均匀性增强。异质性增强的患者无病生存期和总生存期比其他增强类型的患者更长（对数秩检验，P<0.001和P = 0.036）。病理检查显示，异质性增强倾向于在肿瘤周围肝组织中形成间隔。有间隔的肿瘤周围肝组织中CD8细胞的患病率显著高于无间隔的组织（0.83%对0.26%，P<0.001）。有间隔的肝组织中肿瘤周围CD8/Foxp3比值高于无间隔的组织（1.22对0.47，P = 0.001），且CD8/Foxp3>0.8的患者总生存期优于CD8/Foxp3≤0.8的患者（对数秩检验，P = 0.028）。总之，肝实质增强为异质性的肝切除患者倾向于形成肝间隔，这与较高的CD8/Foxp3比值和更长生存期相关。因此，对比增强CT扫描可能是预测HCC预后的有用工具。
