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基于CT和MRI得出的SMARS评分与肝癌组织病理学特征之间的关联。

Associations between the SMARS score derived from CT and MRI with histopathological features in HCC.

作者信息

Romeo Daniele, Richter Theresa, Höhn Anne-Kathrin, Tautenhahn Hans-Michael, Seehofer Daniel, Scheuermann Uwe, Denecke Timm, Meyer Hans-Jonas

机构信息

Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, 49341/9717400, Leipzig, Germany.

Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.

出版信息

Sci Rep. 2025 Jul 10;15(1):24862. doi: 10.1038/s41598-025-09918-8.

Abstract

There are complex associations between the imaging phenotype and underlying histopathology of hepatocellular carcinomas (HCC). The recently proposed SMARS score (acronym comprising Shape of tumour, Mosaic architecture, AFP level, Rim APHE, and Satellite lesion) could discriminate proliferative and non-proliferative HCC tumours in a non-invasive way and was associated with treatment outcomes. However, a systematic validation of this score is needed and it is unclear whether associations with histopathology features exist. The present study elucidates possible correlations between the SMARS score defined by CT and MRI images with immunohistochemistry features of the pathological specimens in a curatively treated HCC cohort. A total of 44 patients (mean age: 59.6 ± 10.7 years) with histologically confirmed HCC, who underwent curative surgical resection, were included in the present analysis. Contrast enhanced MRI and CT images were performed before surgery and the SMARS score was calculated. The pathological specimens were analyzed for programmed death ligand 1 (PD-L1), Glypican-3, CD3-tumour infiltrating lymphocyte, CD68 positive cells, CD34 positive microvessel density (MVD). The median SMARS score derived from MRI images was 1.4 (interquartile range: -0.32; 2.18) and from CT images it was - 0.32 (interquartile range: -1.08; 0.56). According to the proposed threshold, 29 tumours were categorized as proliferative HCC (82.9%) and six tumours as nonproliferative HCC (17.1%) accordingly to the MRI SMARS score. According to the CT SMARS score 24 tumours were categorized as proliferative HCC (61.5%) and 15 as nonproliferative HCC (38.5%). The SMARS score derived from MRI images showed no correlations with the PD-L1, CD68, CD3 and MVD parameters. However, a moderate association was shown between the SMARS score with the Glypican-3 expression (r = 0.37, p = 0.03). The SMARS score derived from CT images, instead, showed correlations with two of the PD-L1 parameters (for PD-L1 tumour positive score r=-0.37, p = 0.02 and for PD-L1 combined positive score r=-0.35, p = 0.03) while no other association with the remaining parameters was detected. The SMARS score as a promising novel imaging score is associated with the Glypican-3 and PD-L1 expression in curatively treated HCC patients. Differences between the CT and MRI defined score needs to be investigated in further trials on larger patient cohorts.

摘要

肝细胞癌(HCC)的影像学表型与潜在组织病理学之间存在复杂的关联。最近提出的SMARS评分(由肿瘤形状、镶嵌结构、甲胎蛋白水平、边缘APHE和卫星病灶的首字母组成)可以以非侵入性方式区分增殖性和非增殖性HCC肿瘤,并且与治疗结果相关。然而,需要对该评分进行系统验证,并且尚不清楚其与组织病理学特征之间是否存在关联。本研究阐明了在接受根治性治疗的HCC队列中,由CT和MRI图像定义的SMARS评分与病理标本的免疫组织化学特征之间可能存在的相关性。本分析纳入了44例经组织学确诊为HCC且接受了根治性手术切除的患者(平均年龄:59.6±10.7岁)。术前进行了对比增强MRI和CT检查,并计算了SMARS评分。对病理标本进行程序性死亡配体1(PD-L1)、磷脂酰肌醇蛋白聚糖-3、CD3肿瘤浸润淋巴细胞、CD68阳性细胞、CD34阳性微血管密度(MVD)分析。由MRI图像得出的SMARS评分中位数为1.4(四分位间距:-0.32;2.18),由CT图像得出的为-0.32(四分位间距:-1.08;0.56)。根据提议的阈值,根据MRI的SMARS评分,29个肿瘤被归类为增殖性HCC(82.9%),6个肿瘤被归类为非增殖性HCC(17.1%)。根据CT的SMARS评分,24个肿瘤被归类为增殖性HCC(61.5%),15个被归类为非增殖性HCC(38.5%)。由MRI图像得出的SMARS评分与PD-L1、CD68、CD3和MVD参数均无相关性。然而,SMARS评分与磷脂酰肌醇蛋白聚糖-3表达之间存在中度关联(r = 0.37,p = 0.03)。相反,由CT图像得出的SMARS评分与两个PD-L1参数相关(PD-L1肿瘤阳性评分r = -0.37,p = 0.02;PD-L1联合阳性评分r = -0.35,p = 0.03),而未检测到与其余参数的其他关联。作为一种有前景的新型影像学评分,SMARS评分与接受根治性治疗的HCC患者的磷脂酰肌醇蛋白聚糖-3和PD-L1表达相关。CT和MRI定义的评分之间的差异需要在更大患者队列的进一步试验中进行研究。

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