CT 三维容积测量对肝癌介入治疗预后评价的初步研究

CT 三维容积测量对肝癌介入治疗预后
评价的初步研究
张家文 刘斌 余永强 李章钧 张国兵 杜临安 张德志 熊壮
【摘要】 目的 综合分析影响肝癌患者介入治疗预后的主要因素, 重点探讨肝癌的CT 三维形
态学对生存率的影响。方法 对经过介入治疗的166 例肝癌患者进行回顾性分析, 所有患者术前及
术后4 周至2 个月行CT 扫描, 明确术前肿瘤的容积、肿瘤与肝脏容积百分比( 瘤肝比) 等形态学特
征, 统计患者的一般资料和临床资料, 并随访患者生存期。应用SPSS 10. 0 统计分析软件, 先进行各
变量对生存率影响单因素分析, 再对单因素分析有意义的变量行多因素Cox 回归分析, 采用Kaplan-
Meier 法计算累积生存率, log-rank 检验方法检验2 组之间的生存曲线有无差别。结果 全组总体
6 个月及1、2、3 年累积生存率分别为: 78. 54% ( 125 / 160 ) 、47. 23% ( 62 /141 ) 、23. 68% ( 19 /123) 、
14. 09% ( 5 /113) ; 中位生存期为12 个月。单因素及多因素Cox 回归分析对预后影响均有意义的变量
有: 瘤肝比、门静脉癌栓、治疗次数及治疗后甲胎蛋白变化。瘤肝比0 ～25% 及26% ～50% 的患者与
51% ～70% 的患者相比, 前2 组生存率较后者明显增高, 3 组中位生存期分别为18、12、7 个月; 瘤肝比
>70% 的肝癌患者介入疗效极差, 中位生存期仅6 个月。结论 ( 1) 肝癌的CT 形态学特征对介入治
疗预后的影响能作出客观的评价。( 2) CT 三维容积测量肝癌容积及瘤肝比较二维测量能更准确地
体现肝癌大小对预后的影响, 瘤肝比是影响肝癌介入治疗预后的具有统计学意义的指标。
【关键词】 癌, 肝细胞; 体层摄影术, X 线计算机; 结果评价( 卫生保健) ; 回归分析
The preliminary study of volumetr ic CT measurement in the pr ognostic evalua tion of patients with
a dvanced primar y liver ca rcinoma t reated by tr anscathet er ar terial chemoembolization ZHANG
J ia -wen* , LIU Bin, YU Yong-qiang, LI Zhang-jun, ZHANG Guo-bing, DU Lin-an, ZHANG De-zhi, XIONG
Zhua ng. Department of Ra diology, the First Affilia ted Hospital of Anhui Medica l University, Hefei 230022,
China * ( Now in: Depatment of Radiology, Hua shan Hospital of Fudan University, Shanghai 200040, China )
Corresponding auther: LIU Bin
【Abstra ct 】 Objective To analyze those major factors affecting the prognosis of primary liver
carcinoma( PLC) patients treated by transcatheter arterial chemoembolization ( TACE) and put emphasis on
the value of volumetric CT measurement on the survival rate. Methods 166 PLC patients treated with TACE
were involved in this retrospective study. The hepatic CT of all patients was performed before TACE and in
4 weeks to 2 months after TACE. The tumor volume, tumor to liver volume ratio( TTLVR) before TACE and
the tumor regression rate , lipiodol( LP) retention after TACE were measured. The clinical data and general
data of the patients were recorded. All patients were followed up by telephone or clinic. Statistical analysis
was performed by SPSS 10. 0 statistical software. The prognostic influence of the following parameters was
evaluated with univariable analysis. Then multivariate Cox regression analysis model was used to analyze
those factors affecting the prognosis to avoid any confounding interaction between them. The cumulative
survival time was calculated according to the Ka plan-Meier method. The prognosis influence of the following
parameters was analyzed by using of the log-rank tests. Results The overall cumulative survival rates for 6,
12, 24 and 36 months were 78. 54% ( 125 /160) , 47. 23% ( 62 /141) , 23. 68% ( 19 /123) and 14. 09% ( 5 /
113) respectively. The median survival time was 12 months. Univariate analysis and multivariate analysis
showed 4 parameters were significant prognostic factors. They were TTLVR, portal cancerous thrombus,
times of treatment and decrease in AFP concentration after treatment. Survival time of patients of which
TTLVR was 0—25% and 50% was more prolonged than that of which TTLVR was 51% —70%, The median
survival time was 18 months, 12 months, 7 months respectively. It was not suitable for TACE when TTLVR
was more than 70% because its median survival time was only 6 months. Conclusion ( 1) Morphologic CT
parameters can have objective evaluation to the prognosis factors of PLC with TACE. ( 2 ) Volumetric CT
technique was a reasonable method to better quantitatively predict the prognosis of patients who underwent
TACE. TTLVR was a significant prognosis factor that influenced the survival of PLC treated by TACE.
【Key words】 Carcinoma, hepatocellular; Tomography, X-ray computed; Outcome assessment
( Heith care) ; Regression analysis

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