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目的探讨依据肝细胞癌(下简称肝癌)的术前临床资料及CT增强影像特征在预测微血管侵犯及根治性切除术后早期复发(1年内复发)中的价值。方法回顾性分析2014年4月至2015年5月期间于我院行肝癌根治性切除术的病例150例,对可能影响肝癌患者微血管侵犯及根治性切除术后早期复发的术前临床资料及CT增强影像特征行单因素及多因素分析。结果单因素分析结果显示,与无微血管侵犯和无早期复发者比较,有微血管侵犯和有早期复发者的病灶较大(P=0.002、P=0.005)、肿瘤边缘不光滑(P<0.001、P<0.001)及病灶多发(P=0.005、P=0.038)所占比例较高,而有微血管侵犯者的包膜不完整(P=0.032)所占比例较高,有早期复发者无包膜及包膜不完整所占比例较高(P=0.038)且癌灶门脉期CT值百分比较高(P=0.049)、癌灶门脉期相对洗脱率较高(P=0.020),其余术前临床资料及CT增强影像特征在有微血管侵犯和有早期复发者和无微血管侵犯及无早期复发者间比较差异均无统计学意义(P>0.05)。多因素logistic逐步回归分析结果显示,肿瘤边缘不光滑(OR=7.075,P<0.001;OR=4.125,P<0.001)和肿瘤多灶性(OR=3.290,P=0.008;OR=2.354,P=0.047)是预测微血管侵犯和根治性切除术后早期复发的重要因素;同时有早期复发者门脉期较快廓清(OR=1.023,P=0.017)。结论肿瘤边缘不光滑和肿瘤多灶性是肝癌微血管侵犯和根治性切除术后早期复发的独立危险因素,有早期复发者在门脉期较快廓清。术前影像检查对预测微血管侵犯和根治性切除术后早期复发有一定的价值,有助于选择合理的治疗方案及预测预后。
Objective To investigate the value of preoperative clinical data and CT-enhanced imaging in predicting microvascular invasion and early recurrence after radical resection (recurrence within one year) based on the results of preoperative hepatocellular carcinoma (HCC). Methods A retrospective analysis of 150 cases of radical resection of hepatocellular carcinoma in our hospital from April 2014 to May 2015 was performed. The clinical data of patients with liver cancer who may affect microvascular invasion and early recurrence after radical resection and CT Enhance the image characteristics of single-factor and multivariate analysis. Results The results of univariate analysis showed that the lesions with microvascular invasion and early recurrence were larger (P = 0.002, P = 0.005), tumor margin was not smooth (P <0.001, P <0.001) and multiple lesions (P = 0.005, P = 0.038), while the percentage of patients with microvascular invasion was higher (P = 0.032). There was no recurrence in the early recurrence The percentage of incomplete capsule was higher (P = 0.038), and the percentage of CT value in portal lesion was higher (P = 0.049), while the relative elution rate in portal lesion was higher (P = 0.020) There was no significant difference between the former clinical data and CT-enhanced imaging features in those with microvascular invasion and those with early recurrence and without microvascular invasion and without early recurrence (P> 0.05). Multivariate logistic stepwise regression analysis showed that the tumor margin was not smooth (OR = 7.075, P <0.001; OR = 4.125, P <0.001) and tumor multifocal (OR = 3.290, P = 0.008; OR = 2.354, P = 0.047) is an important factor in predicting the early recurrence of microvascular invasion and radical resection. In the meantime, the early recanalization of the portal vein phase is faster (OR = 1.023, P = 0.017). Conclusions The tumor margin is not smooth and multifocal tumor is an independent risk factor for microvascular invasion of liver cancer and radical recurrence after radical resection, with early recurrence in the portal phase faster clearance. Preoperative imaging for the prediction of microvascular invasion and radical resection of the early recurrence of a certain value, help to choose a reasonable treatment and prognosis.