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Prognostic Value of MRI Arterial-phase Enhancement Pattern in Intrahepatic Cholangiocarcinoma Patients
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 44, Issue 4, Pages: 668-676(2023)
- 作者机构：
中山大学附属第一医院放射科，广东 广州 510080
- 作者简介：
MA Ling； E-mail： mling@mail.sysu.edu.cn
- 基金信息：
DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).20230508.002
CLC： R445.2Published：20 July 2023，
Received：16 December 2022，
扫 描 看 全 文
陈美成,周小琦,马瑞霞等.MRI动脉期强化模式预测肝内胆管细胞癌患者的预后[J].中山大学学报（医学科学版）,2023,44(04):668-676.
CHEN Mei-cheng,ZHOU Xiao-qi,MA Rui-xia,et al.Prognostic Value of MRI Arterial-phase Enhancement Pattern in Intrahepatic Cholangiocarcinoma Patients[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(04):668-676.
陈美成,周小琦,马瑞霞等.MRI动脉期强化模式预测肝内胆管细胞癌患者的预后[J].中山大学学报（医学科学版）,2023,44(04):668-676. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).20230508.002.
CHEN Mei-cheng,ZHOU Xiao-qi,MA Rui-xia,et al.Prognostic Value of MRI Arterial-phase Enhancement Pattern in Intrahepatic Cholangiocarcinoma Patients[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(04):668-676. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).20230508.002.
摘要
目的
2
探讨术前 MRI增强扫描动脉期强化模式对肝内胆管细胞癌（ICC）无病生存时间（DFS）和术后总生存时间（OS）的预测价值。
方法
2
回顾性分析2018年1月至2021年12月在中山大学附属第一医院手术治疗，术后病理证实为ICC的93例患者的临床、术前增强MRI、术后病理、术后随访资料。采用Kaplan-Meier生存曲线分析比较MRI增强扫描动脉期强化模式不同的三组间的DFS和OS，Cox回归分析影响ICC术后DFS和OS的危险因素。
结果
2
不同动脉期强化模式组术后DFS和OS差别有统计学意义（Log-rank检验，
P
<
0.05）。MRI动脉期强化模式是ICC术后DFS的独立危险因素（以弥漫性高增强为参照，外周环形强化：HR = 3.550； 95%CI： 1.16 ~ 10.8；
P
= 0.026；弥漫性低增强：HR = 3.430； 95%CI： 1.04 ~ 11.3；
P
= 0.042）。MRI动脉期强化模式和肿瘤位置是ICC术后OS的独立危险因素（以弥漫性高增强为参照，弥漫性低增强HR = 8.500； 95%CI： 1.09 ~ 66.3；
P
= 0.041；以肝周为参照，肿瘤位置近肝门HR = 2.583，95%CI： 1.14 ~ 5.83，
P
= 0.022）。动脉期强化模式预测术后1年、2年和3年DFS的受试者特征曲线（ROC）的曲线下面积（AUC）分别为0.722、0.748和0.617，预测患者术后1年、2年和3年OS的AUC分别为0.720、0.704和0.730，预测效能均优于AJCC-TNM分期系统。
结论
2
术前MRI动脉期强化模式是预测ICC术后DFS和OS的可靠指标，优于AJCC-TNM分期系统，有良好的预后预测效能，可用于ICC的临床管理。
Abstract
Objective
2
To investigate the prognostic value of the enhancement pattern in arterial phase of preoperative Gd-EOB-DTPA enhanced magnetic resonance imaging （MRI） in evaluating the disease-free survival （DFS） and overall survival （OS） in patients undergoing curative resection for intrahepatic cholangiocarcinoma （ICC）.
Methods
2
A retrospective analysis was done on the clinical， preoperative MRI findings and postoperative follow-up results of 93 pathologically confirmed ICC patients undergoing surgery in our hospital between January 2018 and December 2021. Kaplan-Meier survival curves and log-rank test were used to compare the DFS and OS of three groups with different arterial enhancement patterns. Cox regression analysis was used to identify the factors affecting DFS and OS.
Results
2
There were significant differences in DFS and OS among the 3 groups （log-rank test，
P
<
0.05）. The arterial enhancement pattern was an independent predictive factor for DFS （using diffuse hyperenhancement as a reference， peripheral rim enhancement： HR = 3.550； 95%CI： 1.16 ~ 10.8；
P
= 0.026；diffuse hypoenhancement： HR = 3.430； 95%CI： 1.04 ~ 11.3；
P
= 0.042）. The arterial enhancement pattern and tumor location were predictive factors for OS （（using diffuse hyperenhancement as a reference， diffuse hypoenhancement， HR = 8.500； 95%CI： 1.09-66.3；
P
= 0.041； using tumor distal location as a reference， tumor perihilar location HR=2.583，95%CI： 1.14-5.83，
P
=0.022）. The AUC of arterial enhancement patterns in predicting 1-， 2-， and 3- year DFS were 0.722， 0.748， and 0.617， respectively； in OS， 0.720， 0.704， and 0.730， respectively， which showed better prognostic efficacy than AJCC-TNM staging system.
Conclusion
2
Arterial-phase enhancement pattern of preoperative Gd-EOB-DTPA enhanced MRI is an independent predictive factor for DFS and OS of ICC patients， with a better prognostic value than AJCC-TNM staging system， and can be used for the clinical management of ICC patients.
关键词
肝内胆管细胞癌磁共振成像动脉期强化模式预后
Keywords
intrahepatic cholangiocarcinoma （ICC）magnetic resonance imaging （MRI）arterial-phase enhancement patternpostoperative survival
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