MRI瘤周特征在预测结直肠癌肝转移非解剖性肝切除术预后的价值

Potential predictor of MRI peritumoral features in prognosis for colorectal liver metastases after non-anatomical hepatectomy

摘要:

目的 研究结直肠肝转移（colorectal liver metastases，CRLM）瘤周影像特征在非解剖切除（non-anatomic resection，NAR）后CRLM患者中长期预后的价值。方法 回顾性纳入术前行腹部钆塞酸二钠增强磁共振成像（magnetic resonance imaging，MRI）和NAR术后的CRLM患者。影像特征评估动脉期瘤周高强化、肝胆期（hepatobiliary phase，HBP）瘤周低摄取和瘤周胆管扩张。应用Kaplan-Meier法计算生存率，并采用Cox比例风险回归模型进行单因素和多因素分析以确定无肝内复发生存期（liver recurrence-free survival，LRFS）、无复发生存期（recurrence-free survival，RFS）和总生存期（overall survival，OS）的独立预测因素。结果 本研究共纳入36例患者，58个CRLM病灶。存在和不存在动脉期瘤周高强化的患者3年LRFS和RFS率有统计学差异（LRFS：14.3% vs. 43.9%，P=0.005；RFS：14.3% vs. 40.3%，P=0.006）。动脉期瘤周高强化与较差的LRFS（P=0.002，HR=5.541，95%CI=1.853~15.975）和较差的RFS（P=0.002，HR=5.392，95%CI=1.887~15.412）独立相关。胆管扩张和HBP瘤周低摄取均不为LRFS、RFS和OS的独立预测因素。结论 动脉期瘤周高强化是接受NAR的CRLM患者LRFS和RFS预后因子。

Abstract:

Objective To evaluate the potential long-term prognostic impact of peritumoral imaging features in patients with colorectal liver metastases（CRLM） after non-anatomic resection（NAR）.Methods Thirty-six patients who had abdominal gadoxetic acid-enhanced magnetic resonance imaging（MRI） before CRLM surgery were included in this retrospective research. Peritumoral early enhancement，peritumoral hypointensity on hepatobiliary phase（HBP），and biliary dilatation to the CRLM at MRI were evaluated. Survival estimates were calculated using the Kaplan-Meier method，and multivariate analysis was conducted to identify independent predictors of liver recurrence-free survival（LRFS）， recurrence-free survival（RFS） and overall survival（OS）.Results Overall， 36 patients with 58 CRLM were evaluated. There was a significant difference in 3-year LRFS and RFS rates between patients with and without peritumoral early enhancement（LRFS：14.3% vs. 43.9%，P=0.005； RFS：14.3% vs. 40.3%，P=0.006）. Peritumoral early enhancement was associated with poor LRFS［P=0.002， hazard ratio（HR）=5.541，95%CI=1.853-15.975］ and poor RFS（P=0.002，HR=5.392，95%CI=1.887-15.412） in patients with CRLM after NAR. However， bile duct dilatation and peritumoral hypointensity on HBP were not independent predictors of LRFS， RFS and OS.Conclusion In patients with CRLM after NAR， peritumoral early enhancement was predictor of LRFS and RFS.