European Radiology:如何应用影像学方法预测肝癌局部治疗后的术后复发?

2022-08-06 shaosai MedSci原创

最近,临床上提出了肝脏影像报告和数据系统治疗反应(LR-TR)算法对LRT后的肿瘤进行逐个影像学评估。

众所周知治疗性肝移植(LT)或切除术仍然是肝细胞癌(HCC)的主要治疗方法,同时局部治疗(LRT)也是重要的新辅助治疗手段之一。具体来说,手术前的LRT可作为降期治疗减少肿瘤负担、增加LT的可能性

在以前的研究中,LRT治疗的HCC的预后受LRT后HCC的数量和大小以及对LRT的反应性的影响。对于治疗反应的评估,改良的实体瘤反应评价标准(mRECIST)评估的治疗反应与单独使用LRT或联合分期LT治疗的患者的复发和生存率有关。最近,临床上提出了肝脏影像报告和数据系统治疗反应(LR-TR)算法对LRT后的肿瘤进行逐个影像学评估。然而,以前的研究大多集中在LR-TR的准确性,只有少数最近的研究报告了其对LRT后生存的预后作用,结果相互矛盾。因此,临床上关于LR-TR算法对LRT术后预后的影响知之甚少。

近日,发表在European Radiology杂志的一项研究评估了预测LRT治疗的HCC治愈性手术后的无复发生存(RFS)和总生存(OS)的临床和包括LR-TR类别在内的影像学因素,并提出了一个术前预后评分系统,为临床进行术前评估提供了影像学参考。

本研究纳入2010年至2016年在LRT后接受肝移植或根治性切除的连续HCC患者,每位患者均有基线和LRT后CT/MRI随访图像。使用Cox比例危险模型评估了手术时的LR-TR类别和其他特征。使用Kaplan-Meier方法和对数秩检验来估计和比较RFS。 

本研究评估了73名患者的115个病灶。手术时LR-TR可行类别(危险比[HR],3.84;95%置信区间[CI]:1.04,14.16)、术前AFP>200 ng/ml(HR,3.63;95%CI:1.63,8.10)、LRT次数>3(HR,4.99;95%CI:1.73,14.38)、以及切除(HR,3.35;95%CI:1.39,8.09)独立预测了复发的可能。风险评分将患者分为差、中和有利风险组,1年RFS率分别为35.0%、78.3%和97.0%(P < 0.001)。手术时的Milan分类以外(HR,5.79;95%CI:1.94,17.07)和术后第一年内的复发(HR,17.66;95%CI:6.42,48.56)都独立预测了死亡。 


 50岁女性肝细胞癌(HCC)的MR和CT图像。动脉MR图像显示肝脏第7有一个4.2厘米的HCC(箭头)(a)。经过一个疗程的药物洗脱珠-TACE治疗后,患者获得了持久的影像学完全反应(b)。肝移植时,对比前(c)和动脉期(d)的MR图像目标病变分配LR-TR非生存类别(箭头)。术前血清AFP水平为3.3纳克/毫升。风险评分为0,患者属于有利的风险组。手术后,证实了病理上可行的肿瘤,60%的肿瘤已经坏死。患者在术后104.6个月内一直存活且无复发

本研究表明,在经LRT治疗的HCC中,超过三个疗程的LRT、术前血清AFP水平>200 ng/mL、LR-TR的影像学可行肿瘤以及肝脏切除与术后RFS短有关。手术时Milan分类以外的病变、切除和术后第一年内的复发与OS降低有关。本研究结果表明,LRT后的最佳手术人选是那些在接受较少的LRT疗程内迅速达到非LR-TR并能接受LT的患者。

原文出处:

Seo Yeon Youn,Bohyun Kim,Dong Hwan Kim,et al.Liver Imaging-Reporting and Data System treatment response algorithm predicts postsurgical recurrence in locoregional therapy-treated hepatocellular carcinoma.DOI:10.1007/s00330-022-08720-8

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    2023-02-05 feather89
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    2022-08-08 chg122
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