CT 三維容積測量對肝癌介入治療預后
評價的初步研究
張家文 劉斌 余永強 李章鈞 張國兵 杜臨安 張德志 熊壯
【摘要】 目的 綜合分析影響肝癌患者介入治療預后的主要因素, 重點探討肝癌的CT 三維形
態學對生存率的影響。方法 對經過介入治療的166 例肝癌患者進行回顧性分析, 所有患者術前及
術后4 周至2 個月行CT 掃描, 明確術前腫瘤的容積、腫瘤與肝臟容積百分比( 瘤肝比) 等形態學特
征, 統計患者的一般資料和臨床資料, 并隨訪患者生存期。應用SPSS 10. 0 統計分析軟件, 先進行各
變量對生存率影響單因素分析, 再對單因素分析有意義的變量行多因素Cox 回歸分析, 采用Kaplan-
Meier 法計算累積生存率, log-rank 檢驗方法檢驗2 組之間的生存曲線有無差別。結果 全組總體
6 個月及1、2、3 年累積生存率分別為: 78. 54% ( 125 / 160 ) 、47. 23% ( 62 /141 ) 、23. 68% ( 19 /123) 、
14. 09% ( 5 /113) ; 中位生存期為12 個月。單因素及多因素Cox 回歸分析對預后影響均有意義的變量
有: 瘤肝比、門靜脈癌栓、治療次數及治療后甲胎蛋白變化。瘤肝比0 ～25% 及26% ～50% 的患者與
51% ～70% 的患者相比, 前2 組生存率較后者明顯增高, 3 組中位生存期分別為18、12、7 個月; 瘤肝比
>70% 的肝癌患者介入療效極差, 中位生存期僅6 個月。結論 ( 1) 肝癌的CT 形態學特征對介入治
療預后的影響能作出客觀的評價。( 2) CT 三維容積測量肝癌容積及瘤肝比較二維測量能更準確地
體現肝癌大小對預后的影響, 瘤肝比是影響肝癌介入治療預后的具有統計學意義的指標。
【關鍵詞】 癌, 肝細胞; 體層攝影術, X 線計算機; 結果評價( 衛生保健) ; 回歸分析
The preliminary study of volumetr ic CT measurement in the pr ognostic evalua tion of patients with
a dvanced primar y liver ca rcinoma t reated by tr anscathet er ar terial chemoembolization ZHANG
J ia -wen* , LIU Bin, YU Yong-qiang, LI Zhang-jun, ZHANG Guo-bing, DU Lin-an, ZHANG De-zhi, XIONG
Zhua ng. Department of Ra diology, the First Affilia ted Hospital of Anhui Medica l University, Hefei 230022,
China * ( Now in: Depatment of Radiology, Hua shan Hospital of Fudan University, Shanghai 200040, China )
Corresponding auther: LIU Bin
【Abstra ct 】 Objective To analyze those major factors affecting the prognosis of primary liver
carcinoma( PLC) patients treated by transcatheter arterial chemoembolization ( TACE) and put emphasis on
the value of volumetric CT measurement on the survival rate. Methods 166 PLC patients treated with TACE
were involved in this retrospective study. The hepatic CT of all patients was performed before TACE and in
4 weeks to 2 months after TACE. The tumor volume, tumor to liver volume ratio( TTLVR) before TACE and
the tumor regression rate , lipiodol( LP) retention after TACE were measured. The clinical data and general
data of the patients were recorded. All patients were followed up by telephone or clinic. Statistical analysis
was performed by SPSS 10. 0 statistical software. The prognostic influence of the following parameters was
evaluated with univariable analysis. Then multivariate Cox regression analysis model was used to analyze
those factors affecting the prognosis to avoid any confounding interaction between them. The cumulative
survival time was calculated according to the Ka plan-Meier method. The prognosis influence of the following
parameters was analyzed by using of the log-rank tests. Results The overall cumulative survival rates for 6,
12, 24 and 36 months were 78. 54% ( 125 /160) , 47. 23% ( 62 /141) , 23. 68% ( 19 /123) and 14. 09% ( 5 /
113) respectively. The median survival time was 12 months. Univariate analysis and multivariate analysis
showed 4 parameters were significant prognostic factors. They were TTLVR, portal cancerous thrombus,
times of treatment and decrease in AFP concentration after treatment. Survival time of patients of which
TTLVR was 0—25% and 50% was more prolonged than that of which TTLVR was 51% —70%, The median
survival time was 18 months, 12 months, 7 months respectively. It was not suitable for TACE when TTLVR
was more than 70% because its median survival time was only 6 months. Conclusion ( 1) Morphologic CT
parameters can have objective evaluation to the prognosis factors of PLC with TACE. ( 2 ) Volumetric CT
technique was a reasonable method to better quantitatively predict the prognosis of patients who underwent
TACE. TTLVR was a significant prognosis factor that influenced the survival of PLC treated by TACE.
【Key words】 Carcinoma, hepatocellular; Tomography, X-ray computed; Outcome assessment
( Heith care) ; Regression analysis

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