文献类型：期刊文献

中文题名：肝细胞癌患者TACE治疗前后增强CT参数变化及与临床疗效关系

英文题名：The correlation between the changes in contrast-enhanced CT parameters and clinical efficacy in patients with hepatocellular carcinoma after receiving TACE

作者：张继续[1];吴军[1];张沅[1];杨祯忠[1];许晓冬[1];王琳[2]

第一作者：张继续

机构：[1]兰州市第二人民医院放射科,甘肃兰州730000;[2]甘肃中医药大学附属第一医院放射科

第一机构：兰州市第二人民医院放射科,甘肃兰州730000

年份：2026

卷号：35

期号：1

起止页码：38

中文期刊名：介入放射学杂志

外文期刊名：Journal of Interventional Radiology

收录：;北大核心:【北大核心2023】；

语种：中文

中文关键词：肝细胞肝癌;经动脉导管化疗栓塞术;增强CT扫描;临床疗效;相关性

外文关键词：hepatocellular carcinoma;transcatheter arterial chemoembolization;contrast-enhanced CT scan;clinical curative effect;correlation

摘要：目的探讨肝细胞癌(HCC)患者经动脉灌注化疗栓塞术(TACE)治疗前后增强CT(contrast-enhanced CT,CECT)参数变化及与临床疗效关系。方法前瞻性选取2021年9月至2024年10月兰州市第二人民医院收治的106例HCC患者纳入研究,均予以TACE治疗及CECT扫描,比较患者治疗前、治疗后6个月CECT参数水平的差异,并据疗效评价标准将患者分为有效组及无效组,应用ROC曲线及曲线下面积(AUC)分析治疗前后CECT参数变化与疗效的关系。结果随访6个月,与治疗前比较,106例HCC患者TACE治疗后CECT参数病灶强化达峰时间(TP)延长(P<0.05),强化峰值(PH)、病灶与主动脉强化峰值之比(M/A)、灌注值水平均降低(P<0.05)。TACE总有效率为67.92%(72/106),据此分为有效组(n=72)及无效组(n=34),两组治疗前后TP、M/A及△TP、△M/A水平比较差异无统计学意义(P>0.05);与治疗前比较,治疗后PH、灌注值水平有效组均降低,无效组均升高(P<0.05),且有效组均低于无效组(P<0.05);与无效组比较,有效组△PH、△灌注值水平均升高,Child-Pugh分级B级占比降低(P<0.05)。ROC曲线结果显示,CECT参数△PH、△灌注值单独及联合评估HCC患者TACE临床疗效的AUC分别为0.864、0.829、0.918(P<0.05),且以联合检测的灵敏度、特异度最高。多因素logistic回归分析结果显示,Child-Pugh分级B级、合并乏血供肿瘤是影响HCC患者TACE疗效的危险因素(P<0.05)。结论HCC患者TACE治疗后CECT参数PH、灌注值、M/A下降,TP升高,其中PH、灌注值治疗前后的变化量可为TACE临床疗效的准确评估提供参考指导。
Objective To explore the relationship between the changes in contrast-enhanced CT(CECT)parameters and clinical efficacy in patients with hepatocellular carcinoma(HCC)after transarterial chemoembolization(TACE)treatment.Methods A total of 106 patients with HCC,who were admitted in Lanzhou Municipal Second People's Hospital from September 2021 to October 2024,were prospectively enrolled in this study.All patients were treated with TACE and underwent CECT scans before and after TACE.The differences in CECT parameters between postoperative 6-month values and preoperative values were compared.Based on the modified Response Evaluation Criteria in Solid Tumors(mRECIST),the patients were divided into an effective group and an ineffective group.ROC curve and area under the curve(AUC)were used to analyze the correlation between the postoperative changes in CECT parameters and clinical efficacy.Results All the patients were followed up for 6 months.Compared with the preoperative values of CECT parameters,the post-TACE time to peak(TP)was extended,while the peak height(PH),ratio of lesion to aorta enhancement peak(M/A),and perfusion value were decreased(all P<0.05).The total response rate of TACE was 67.92%(72/106),based on which the patients were divided into effective group(n=72)and ineffective group(n=34).There was no statistically significant differences in TP,M/A,△TP and△M/A between the two groups before and after treatment(all P>0.05).Compared with the preoperative values,the postoperative PH and perfusion values were decreased in the effective group but increased in the ineffective group(both P<0.05),in addition,the PH and perfusion values in effective group were lower than those in ineffective group(both P<0.05).Compared with the ineffective group,in the effective group the△PH and△perfusion values were higher and the proportion of Child-Pugh of grade B was lower(all P<0.05).The results of ROC curves analysis showed that AUC value of△PH,△perfusion value and combined detection for evaluating clinical curative effect of TACE in HCC patients were 0.864,0.829 and 0.918 respectively(all P<0.05).Both the sensitivity and specificity of combined detection were the highest.The results of multivariate logistic regression analysis revealed that Child-Pugh of grade B and tumors having poor blood supply were the risk factors affecting the curative effect of TACE in HCC patients(P<0.05).Conclusion In HCC patients after receiving TACE,the CECT parameters including PH,perfusion value and M/A are decreased,while TP is increased.The postoperative changes in PH and perfusion value can provide useful reference for accurately evaluating the clinical efficacy of TACE.