钆塞酸二钠增强MRI特征影响肝细胞癌切除术后肿瘤复发因素分析*

doi:10.3969/j.issn.1672-5069.2026.04.029

摘要/Abstract

摘要： 目的探讨钆塞酸二钠增强MRI特征预测肝细胞癌(HCC)患者术后肿瘤复发的价值,为临床评估HCC术后复发风险提供客观影像学依据。方法 2022年6月~2025年6月我院收治的58例HCC患者均接受肝叶切除术,随访至2026年2月。术前行增强MR扫描,测量平扫、动脉期、门静脉期、移行期和肝胆期同一层面病灶与正常肝实质的信号强度,计算相对信号强度比(RIR)。采用免疫组化法检测肝组织细胞角蛋白 19(CK19)表达。采用多因素 Logistic 回归分析影响因素。结果本组HCC患者术后肿瘤复发23例(39.7%);复发组基线异常凝血酶原、甲胎蛋白水平、肿瘤直径、肿瘤细胞低分化、CK19阳性和T2N0M0占比均显著高于或大于未复发组(P＜0.05);复发组肿瘤MR增强扫描肝胆期RIR为(0.5±0.2),显著低于无复发组【(0.7±0.1),P<0.05】;多因素 Logistic 回归分析显示,异常凝血酶原、肿瘤细胞低分化、TNM分期、马赛克征和肝胆期瘤周低信号均为影响肝细胞癌术后肿瘤复发的独立危险因素,而肝胆期RIR为肝细胞癌术后复发的独立性保护因素(P＜0.05)。结论增强MRI特征联合血清和临床指标可帮助判断HCC患者术后肿瘤复发风险,为临床制定个体化的随访策略提供重要参考。

关键词: 肝细胞癌, 钆塞酸二钠, 磁共振成像, 肝叶切除术, 复发, 危险因素

Abstract: Objective The aim of this study was to investigate magnetic resonance imaging (MRI) features impacting recurrence of tumor in patients with hepatocellular carcinoma (HCC) after hepatectomy. Methods 58 patients with HCC were encountered in our hospital between June 2022 and June 2025, and all underwent hepatectomy after gadoxetic acid disodium-enhanced MRI scan. Patients were followed-up until February 2026. Relative intensity ratio (RIR) was calculate based on MRI. Cytokeratin 19 (CK19) expression was detected by immunochemical staining. Multivariate Logistic regression analysis was applied to find impacting factors for tumor recurrence. Results By end of follow-up, intrahepatic tumor recurrence was found in 23 cases (39.7%) in our series; baseline serum protein induced by vitamin K absence or antagonist-II (PIVKA-II), alpha fetoprotein levels, diameters of tumors, poor histological differentiation, CK19 positive rate and percentage of T2N0M0 in tumor recurrence group were significantly higher or greater than in non-recurrence group (P＜0.05); RIR at hepatobiliary phase was (0.5±0.2), much lower than [(0.7±0.1),P<0.05] in non-recurrence group; multivariate Logistic regression analysis showed that serum PIVKA-II, poor differentiation, TNM staging, mosaic pattern and peritumoral hypointensity at hepatobiliary phase were all the independent risk factors, while RIR at hepatobiliary phase was the independent protective factor(P＜0.05) for tumor recurrence. Conclusion Gadoxetic acid disodium-enhanced MRI features in combination with clinical materials could help predict tumor recurrence in patients with HCC after hepatectomy, which might guide individualized surveillance strategies.

Key words: Hepatoma, Gadoxetic acid disodium-enhanced magnetic resonance imaging, Hepatectomy, Tumor recurrence, Risk factors

陈苏闽, 王海霞, 江凯, 王旭丽. 钆塞酸二钠增强MRI特征影响肝细胞癌切除术后肿瘤复发因素分析^*[J]. 实用肝脏病杂志, 2026, 29(4): 593-596.

Chen Sumin, Wang Haixia, Jiang Kai, et al. MRI features impacting recurrence of tumor in patients with hepatocellular carcinoma after hepatectomy[J]. Journal of Practical Hepatology, 2026, 29(4): 593-596.

参考文献

[1] Singh S P, Madke T, Chand P. Global epidemiology of hepatocellular carcinoma. J Clin Exp Hepatol, 2025, 15(2): 102446.
[2] 朱超凡,加静,王丹. 癌组织KK-LC-1表达对靶向和免疫治疗手术切除的肝细胞癌患者预后的影响. 实用肝脏病杂志,2026,29(1):125-128.
[3] Wu J, Chan Y T, Lu Y, et al. The tumor microenvironment in the postsurgical liver: mechanisms and potential targets of postoperative recurrence in human hepatocellular carcinoma. Med Res Rev, 2023, 43(6): 1946-1973.
[4] 冯胜菊,臧翌辰,佟晓,等. 肝癌组织脂肪酸转位酶表达对手术切除治疗患者预后的影响. 实用肝脏病杂志,2025,28(4):633-635.
[5] Norman J S, Li P J, Kotwani P, et al. AFP-L3 and DCP strongly predict early hepatocellular carcinoma recurrence after liver transplantation. J Hepatol, 2023, 79(6): 1469-1477.
[6] Qiu Z C, Li C, Zhang Y, et al. Tumor burden score-AFP-albumin-bilirubin grade score predicts the survival of patients with hepatocellular carcinoma after liver resection. Langenbecks Arch Surg, 2023, 408(1): 250.
[7] 吉盛超,耿承军,陆泽华,等. 基于增强CT和MRI参数构建模型鉴别诊断不典型肝细胞癌与肿块型肝内胆管细胞癌价值研究. 实用肝脏病杂志,2026,29(2):281-284.
[8] Ding F, Huang M, Ren P, et al. Quantitative information from gadobenate dimeglumine-enhanced MRI can predict proliferative subtype of solitary hepatocellular carcinoma: a multicenter retrospective study. Eur Radiol, 2024, 34(4): 2445-2456.
[9] 中华医学会肝病学分会肝癌学组,中华肝脏病杂志编辑委员会. 肝细胞癌癌前病变诊断和治疗多学科专家共识(2023年版). 中华肝脏病杂志,2023,31(12):1250-1261.
[10] Singal A G, Kanwal F, Llovet J M. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol, 2023, 20(12): 864-884.
[11] Lampimukhi M, Qassim T, Venu R, et al. A review of incidence and related risk factors in the development of hepatocellular carcinoma. Cureus, 2023, 15(11): e49429.
[12] Heo S, Yang J, Park J, et al. Association between viral replication activity and postoperative recurrence of HBV-related hepatocellular carcinoma. Aliment Pharmacol Ther, 2025, 61(10): 1680-1691.
[13] Li G, Li N, Li S, et al. Expression and diagnostic value of abnormal prothrombin and osteopontin in hepatocellular carcinoma with cirrhosis. Am J Transl Res, 2024, 16(9): 4688.
[14] Tian S, Chen Y, Zhang Y, et al. Clinical value of serum AFP and PIVKA-II for diagnosis, treatment and prognosis of hepatocellular carcinoma. J Clin Lab Anal, 2023, 37(1): e24823.
[15] Liu S Y, Dai M G, Lu W F, et al. Prognostic value of des-gamma-carboxy prothrombin in AFP-Negative hepatocellular carcinoma patients following liver resection: a multicenter study. J Cancer, 2025, 16(8): 2680.
[16] Zhang J, Li Y, Xia J, et al. Prediction of microvascular invasion and recurrence after curative resection of LI-RADS category 5 hepatocellular carcinoma on Gd-BOPTA enhanced MRI. J Hepatocell Carcinoma, 2024, 25(11): 941-952.
[17] Huang Z, Pan Y, Huang W, et al. Predicting microvascular invasion and early recurrence in hepatocellular carcinoma using DeepLab V3+ segmentation of multiregional MR habitat images. Acad Radiol, 2025, 32(6): 3342-3357.
[18] Sheng R, Zheng B, Zhang Y, et al. A preliminary study of developing an MRI-based model for postoperative recurrence prediction and treatment direction of intrahepatic cholangiocarcinoma. Radiol Med, 2024, 129(12): 1766-1777.
[19] Wang Y J, Xu J X, Ke T Y, et al. A scoring model based on MRI features for predicting early recurrence after surgical resection of hepatocellular carcinoma. Front Surg, 2025, 1(12): 1488276.
[20] Lu M, Qu Q, Xu L, et al. Prediction for aggressiveness and postoperative recurrence of hepatocellular carcinoma using gadoxetic acid-enhanced magnetic resonance imaging. Acad Radiol, 2023, 30(5): 841-852.
[21] Zhang Y, Yang C, Sheng R, et al. Predicting the recurrence of hepatocellular carcinoma (≤ 5 cm) after resection surgery with promising risk factors: habitat fraction of tumor and its peritumoral micro-environment. Radiol Med, 2023, 128(10): 1181-1191.
[22] Nevola R, Ruocco R, Criscuolo L, et al. Predictors of early and late hepatocellular carcinoma recurrence. World J Gastroenterol, 2023, 29(8): 1243-1260.
[23] Zhang J X, Guo L B, Zeng C S, et al. Time to recurrence and BCLC stage at recurrence as critical variables in guiding treatment decisions for early-recurrent hepatocellular carcinoma after liver resection. Front Oncol, 2025, 3(15): 1672696.
[24] Han R, Gan L, Lang M, et al. A retrospective study on predicting recurrence of intermediate-stage hepatocellular carcinoma after radical therapy. J Hepatocell Carcinoma, 2024, 12(11): 51-64.

钆塞酸二钠增强MRI特征影响肝细胞癌切除术后肿瘤复发因素分析^*

MRI features impacting recurrence of tumor in patients with hepatocellular carcinoma after hepatectomy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	左仁智, 王凯旋, 葛尚. 39例肝细胞腺瘤影像学特点分析^*[J]. 实用肝脏病杂志, 2026, 29(4): 609-612.
[2]	夏炜, 丛苗苗. 微创保胆取石术治疗胆囊结石患者结石复发风险因素分析研究^*[J]. 实用肝脏病杂志, 2026, 29(4): 613-616.
[3]	潘柏舟, 王若森, 孙倍成. 基于机器学习的多模态数据预测CNLCⅠ/Ⅱa期肝细胞癌切除术后早期复发价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 397-400.
[4]	徐小虎, 王维, 马秋莲, 于蓉, 许亚春, 祁荣兴. 增强MRI联合血清AFP和PIVKA-II诊断肝细胞癌应用研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 405-408.
[5]	王立峰, 李岩, 刘翠翠, 袁德昌, 许春苗, 陈学军, 韩帅. 双表型肝细胞癌患者增强磁共振成像表现特征分析^*[J]. 实用肝脏病杂志, 2026, 29(3): 409-412.
[6]	郝秀秀, 张朝赫, 武翀, 靳福全, 张伟, 周婕, 查润民, 张一峰, 韩治宇, 周赟. 超声引导下纳米刀消融治疗肝细胞癌患者效果分析^*[J]. 实用肝脏病杂志, 2026, 29(3): 421-424.
[7]	魏雨梦, 韩高飞, 高潘. 增强CT纹理参数预测肝细胞癌病理学分化程度价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 425-428.
[8]	程琪, 耿承军, 金晓凤, 徐文韬, 王骁. MRI联合扩散加权成像鉴别诊断不典型肝脓肿与肝内转移癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 446-449.
[9]	周慧敏, 王娜, 刘晶晶, 郭亚荣, 柴宝. 内镜下硬化剂治疗肝硬化并发食管静脉曲张破裂出血患者心肌损伤临床研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 265-268.
[10]	吉盛超, 耿承军, 陆泽华, 叶黛西, 冯浩, 金晓凤, 陈利华. 基于增强CT和MRI参数构建模型鉴别诊断不典型肝细胞癌与肿块型肝内胆管细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 281-284.
[11]	李杰, 季敏君, 刘晓艳, 王庆庆, 倪鑫. 经肝动脉灌注化疗栓塞术联合仑伐替尼治疗中晚期肝细胞癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 289-292.
[12]	蔡蓉蕾, 廖荣信, 罗伟, 唐良俊. 三维适形放疗治疗原发性肝癌患者放射性肝损伤增强MRI表现特征分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 297-300.
[13]	石国富, 朱志韬, 张苏波, 金怀玉. MSCT联合增强MRI鉴别诊断肝脏局灶性结节性增生与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 301-304.
[14]	王威, 孟云, 冀鹏. 磁共振增强扫描量化参数鉴别诊断肝脏良恶性占位性病变价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 305-308.
[15]	袁伟文, 刘金武, 董婷, 何娴, 文华. 基于MRI水脂分离检测肝脏质子密度脂肪分数评估NAFLD患者脂肪变性程度应用研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 61-64.