PDF(Pubmed)
Abstract：
This study aimed to define the role of heterogeneity of liver parenchymal enhancement on computed tomography (CT) in the survival of patients with hepatocellular carcinoma (HCC) after hepatic resection. The medical records of patients with HCCs and who had undergone hepatic resection were retrospectively reviewed. The standard deviation (SD) of three different enhanced CT scan images was used to estimate the heterogeneity of liver parenchymal enhancement: SD of > 5.6, heterogenous enhancement, and SD of ≤ 5.6, homogeneous enhancement. A total of 57 patients had heterogenous enhancement, and 143 patients had homogeneous enhancement. The patients with heterogenous enhancement had longer disease-free and overall survivals than those with other enhancements (log-rank test, P < 0.001 and P = 0.036). The pathologic exam showed that heterogenous enhancement tended to develop septa in the peritumoral liver tissues. The prevalence of CD8+ cells was significantly higher in the peritumor liver tissues with septa than in those without (0.83% vs. 0.26%, P < 0.001). The peritumoral CD8/Foxp3 ratio was higher in the liver tissues with septa than in those without (1.22 vs. 0.47, P = 0.001), and patients with CD8/Foxp3 of > 0.8 had better overall survival than those with CD8/Foxp3 of ≤ 0.8 (log-rank test, P = 0.028). In conclusion, patients who had undergone hepatic resection with a heterogenous liver parenchymal enhancement tended to develop hepatic septa, which was associated with a higher CD8/Foxp3 ratio and longer survival. Therefore, contrast-enhanced CT scans might be a useful tool to predict the outcome of HCC.
摘要：
这项研究旨在确定肝脏实质增强的异质性在计算机断层扫描（CT）肝切除术后肝细胞癌（HCC）患者的生存中的作用。回顾性分析了接受肝切除术的HCC患者的病历。使用三种不同增强CT扫描图像的标准偏差（SD）来估计肝实质增强的异质性：SD>5.6，异质性增强，SD≤5.6，均匀增强。共有57例患者有异质性增强，143例患者均有强化。具有异质性增强的患者比具有其他增强的患者具有更长的无病和总体生存率（对数秩检验，P<0.001和P=0.036）。病理检查显示，异质增强倾向于在瘤周肝组织中形成间隔。CD8+细胞的患病率在有隔片的瘤周肝组织中明显高于无隔片的组织(0.83%vs.0.26%，P<0.001)。在有隔片的肝组织中，肿瘤周CD8/Foxp3比率高于无隔片的肝组织（1.22vs.0.47，P=0.001），CD8/Foxp3>0.8的患者总生存率优于CD8/Foxp3≤0.8的患者（log-rank检验，P=0.028)。总之,接受肝切除术的患者肝实质异质性增强倾向于发展肝间隔，这与更高的CD8/Foxp3比率和更长的生存期有关。因此,对比增强CT扫描可能是预测HCC预后的有用工具.
