摘要
目的:探讨钆塞酸二钠多模态MRI联合临床特征构建的列线图模型同时预测肝细胞癌(HCC)中CK19表达及微血管侵犯(MVI)的价值.方法:回顾性搜集经病理诊断为单发性HCC的106例患者的病例资料,术前均行钆塞酸二钠增强多模态MRI检查,且术后病理报告清晰描述CK19及MVI状态.将CK19/MVI双生物学标志物分为双阳组(CK19及MVI均为阳性,19例)与非双阳组(87例),比较两组间临床及影像特征的差异,通过多因素Logistic回归筛选独立预测因子,并通过R软件构建CK19/MVI双阳性表达的列线图模型.结果:临床特征中年龄、AFP、NLR、PLR在双阳组与非双阳组间差异有统计学意义(P＜0.05),影像特征中T1rt-pre、T1rt-20 min、ADC值、肿瘤直径、肿瘤包膜、肿瘤边缘、坏死、瘤周强化、肝胆期瘤周低信号在两组间差异有统计学意义(P＜0.05),其余参数在两组间差异无统计学意义(P＞0.05).多因素Logistic回归分析结果显示PLR、T1rt-20 min、肝胆期瘤周低信号是CK19/MVI双阳表达的独立预测因子,各预测因子的ROC曲线下面积(AUC)分别为0.729、0.706、0.708.建立的列线图预测模型AUC为0.854,校准预测曲线与标准曲线贴合尚可.结论:钆塞酸二钠增强多模态MRI联合临床特征术前能较好地同时预测CK19表达及微血管侵犯,并通过列线图模型为个体化预测提供参考.
Abstract
Objective:To investigate the value of a nomogram for the simultaneous prediction of CK19 expression and microvascular invasion(MVI)in hepatocellular carcinoma(HCC),by integra-ting the clinical features with Gd-EOB-DTPA enhanced multimodal MRI.Methods:The data of 106 pa-tients with pathological diagnosis of solitary HCC were retrospectively collected.All patients under-went preoperative Gd-EOB-DTPA enhanced multimodal MRI examination,and the postoperative path-ological report clearly described CK19 immunohistochemistry and MVI.The CK19/MVI dual biomark-ers were divided into"double-positive"group(19 cases)and non-"double-positive"group(87 cases).Statistical differences in clinical and imaging characteristics were compared between the two groups.Independent predictors were identified by multivariate logistic regression,and a nomogram was devel-oped using R software to predict the CK19/MVI"double-positive"status in HCC.Results:In clinical features,there were significant differences in age,AFP,NLR,and PLR between"double-positive"and non-"double-positive"groups(P＜0.05).In imaging features,T1rt-pre,T1rt-20min,ADC,tumor di-ameter,tumor capsule,tumor margin,necrosis,and peritumoral enhancement and peritumoral hypoin-tensity on HBP were significantly different between the two groups(P＜0.05),but there was no sta-tistical difference in other parameters(P＞0.05).Multivariate logistic regression analysis showed that PLR,T1rt-20min,and peritumoral hypointensity on HBP were independent predictors of CK19/MVI"double positive"expression The area under the receiver operating characteristic curve of each inde-pendent predictor were 0.729,0.706,and 0.708,respectively.The AUC of the nomogram is 0.854.The nomogram revealed excellent agreement between the corrected predictive curve and the ideal curve.Conclusion:Gd-EOB-DTPA enhanced multimodal MRI,in combination with clinical features,can bet-ter simultaneously predict CK19 expression and MVI before surgery,as well as provide individualized prediction through nomogram.
基金项目
广东省中医药局科研项目(20241312)
广东省医学科学技术研究项目(A2024022)
广东省医学科学技术研究项目(A2021483)
佛山市自筹经费类科技计划(2320001006750)
南方医科大学顺德医院科研启动项目(SRSP2021021)
南方医科大学顺德医院科研启动项目(SRSP2023008)
万方数据