多模态超声评估原发性肝癌微血管侵犯及对经肝动脉栓塞化疗治疗后肿瘤复发的影响*

doi:10.3969/j.issn.1672-5069.2025.06.026

摘要/Abstract

摘要： 目的应用多模态超声评估肝癌组织微血管侵犯(MVI)以及对介入术后肿瘤复发的影响。方法 2022年1月～2024年1月我院诊治的63例肝细胞癌(HCC)患者,均接受经肝动脉栓塞化疗(TACE)治疗,随访12个月。术前均接受常规超声和超声造影检查,行肿瘤组织血流信号评分和血流信号分布分型。应用多因素Logistic回归分析影响肝癌组织发生MVI的因素。结果经病理学检查,在63例HCC患者中,发现存在MVI者27例(42.9%),无MVI(nMVI)者36例(57.1%);MVI组肿瘤≥5cm、肿瘤包膜不完整、肿瘤边缘不光滑、血流信号评分、Ⅲ型血流信号、瘤周强化、门脉期和延迟期呈等低增强占比分别为63.0%、66.7%、63.0%、(1.9±0.5)分、70.4%、48.2%、92.6%和96.3%,均显著大于nMVI组(分别为36.1%、38.9%、36.1%、(1.4±0.3)分、42.7%、19.4%、69.4%和77.8%,P＜0.05),而廓清时间为(60.8±15.5)s,显著短于nMVI组【(82.7±21.6)s,P＜0.05】;多因素Logistic回归分析显示血流信号分级、延迟期增强和廓清时间均为提示HCC组织存在MVI的影响因素(P＜0.05);在随访12个月末,MVI组肿瘤增大复发率为70.4%,显著高于nMVI组的25.0%(P＜0.05)。结论应用多模态超声指标评估HCC组织MVI有一定的临床意义,或可帮助制定TACE治疗次数。

关键词: 肝细胞癌, 微血管侵犯, 经肝动脉栓塞化疗, 多模态超声, 治疗

Abstract: Objective The aim of this study was to explore multimodal ultrasound in evaluating microvascular invasion (MVI) in patients with primary liver cancer (PLC) receiving transarterial chemoembolization (TACE). Methods 63 patients with hepatocellular carcinoma (HCC) were encountered in our hospital between January 2022 and January 2024, and all of them received TACE and followed-up for 12 months. All patients underwent multimodal ultrasound examination before surgery for intratumorous blood flow signal evaluation. Multivariate Logistic regression analysis was performed to identify the factors hinting MVI existence. Results Liver histo-pathological examination found MVI in 27 cases(42.9%) out of our 63 patients with HCC; the proportions of patients with tumors ≥ 5 cm, incomplete tumor capsule, unsmoothed tumor edges, tumor blood flow signal score, type III blood flow signal, peritumoral enhancement, equal and low enhancement at portal vein phase and at delayed phase in the MVI group were 63.0%, 66.7%, 63.0%, (1.9±0.5), 70.4%, 48.2%, 92.6% and 96.3%, all significantly greater than 36.1%, 38.9%, 36.1%, (1.4±0.3), 42.7%, 19.4%, 69.4% and 77.8% (P＜0.05) in those without MVI, while the clearance time was (60.8±15.5)s, significantly shorter than [(82.7±21.6)s, P＜0.05] in those without MVI; multivariate Logistic regression analysis showed that blood flow signal, enhancement at delayed phase and clearance time were the independent factors indicating MVI occurrence(P＜0.05); by end of 12-month follow-up, the deteriorated tumors was 70.4% in MVI group, much higher than 25.0%(P＜0.05) in tumors without MVI. Conclusion Multimodal ultrasound is helpful in evaluating MVI before TACE operation, which might guide make decisions for appropriate TACE plan.

Key words: Hepatoma, Microvascular invasion, Transarterial chemoembolization, Multimodal ultrasound, Therapy

郭健伟, 贾健峰, 阳春, 刘娜, 曾勇, 李齐刚. 多模态超声评估原发性肝癌微血管侵犯及对经肝动脉栓塞化疗治疗后肿瘤复发的影响^*[J]. 实用肝脏病杂志, 2025, 28(6): 902-905.

Guo Jianwei, Jia Jianfeng, Yang Chun, et al. Multimodal ultrasound in evaluating microvascular invasion in patients with primary liver cancer receiving transarterial chemoembolization[J]. Journal of Practical Hepatology, 2025, 28(6): 902-905.

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多模态超声评估原发性肝癌微血管侵犯及对经肝动脉栓塞化疗治疗后肿瘤复发的影响^*

Multimodal ultrasound in evaluating microvascular invasion in patients with primary liver cancer receiving transarterial chemoembolization

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