Value of color Doppler ultrasound combined with hepatic artery related index in predicting the effect and prognosis of interventional chemotherapy for elderly primary liver cancer
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摘要:
目的探讨彩色多普勒超声联合肝动脉相关指数预测老年原发性肝癌（PLC）介入化疗疗效及预后的价值。 方法回顾性分析2017年3月~2018年12月本院收治的236例老年（>60岁）PLC患者的临床资料。统计老年PLC患者治疗情况；对比无效组和有效组患者的临床资料；Logistic回归分析影响老年PLC患者TACE治疗效果的因素；制作受试者工作特征曲线（ROC），分析肝动脉相关指数对老年PLC患者治疗效果的预测价值；术后随访1年，肝动脉相关指数分析老年PLC患者预后情况。 结果本研究老年PLC患者经TACE治疗后，治疗无效发生率为24.58%。Logistic回归分析结果显示，病理分型为低分化、肝动脉收缩期峰值（PSV）及肝动脉搏动指数（PI）均为影响老年PLC患者TACE治疗效果的因素（OR=4.011、3.340、2.807，P < 0.05）。ROC分析显示，PSV、PI预测老年PLC患者治疗无效的最佳截断点分别为82.42 cm/s、1.73，曲线下面积值分别为0.772、0.753。预后不良组PSV、PI均显著高于预后不良组（P < 0.05）。 结论彩色多普勒超声联合PSV、PI预测老年PLC介入化疗疗效及预后效能较高，可作为评估疗效及预后的重要指标。 Abstract:ObjectiveTo explore the value of color Doppler ultrasound combined with hepatic artery related index in predicting the efficacy and prognosis of interventional chemotherapy for elderly patients with primary liver cancer (PLC). MethodsThe clinical data of 236 elderly patients with PLC admitted to our hospital from March 2017 to December 2018 were retrospectively analyzed. Statistics of elderly patients with PLC were analyzed. The clinical data of patients in the invalid group and the effective group were compared. Logistic regression analysis was used to analyze the factors of TACE treatment in elderly patients with PLC. ROC was used to analyze the predictive value of hepatic artery correlation index for the treatment effect of elderly patients with PLC. After 1 year follow-up, the hepatic artery related index was used to analyze the prognosis of elderly patients with PLC. ResultsThe incidence of treatment failure in elderly PLC patients was 24.58% after TACE treatment. The pathological classification was poorly differentiated. Peak hepatic artery systole (PSV) and Hepatic artery pulsation index (PI) were all factors affecting the treatment effect of TACE in elderly patients with PLC (OR=4.011, 3.340, 2.807, all P < 0.05). ROC analysis showed that the best cut-off points for PSV and PI to predict treatment failure in elderly PLC patients were 82.42 cm/s and 1.73, respectively. The AUC values were 0.772 and 0.753, respectively. The PSV and PI of the poor prognosis group were significantly higher than those of the poor prognosis group (P < 0.05). ConclusionColor doppler ultrasound combined with PSV and PI has a higher efficacy in predicting the efficacy and prognosis of PLC interventional chemotherapy in the elderly. It can be used as an important indicator for evaluating the efficacy and prognosis. -
Key words:
- elderly /
- primary liver cancer /
- color Doppler ultrasound /
- hepatic artery index /
- chemotherapy /
- prognosis
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图 1 老年PLC彩色多普勒超声检查图
A：性别男，年龄72岁，BCLC分期IIa，child分级B，肿瘤数目3，PSV：67.76 cm/s，RI：0.86，DPI：0.39，PI：1.53；B：性别男，年龄68岁，BCLC分期IIIa，child分级B，肿瘤数目2，PSV：89.65 cm/s，RI：0.88，DPI：0.52，PI：1.59.
Figure 1. Color Doppler ultrasound examination of elderly PLC.
图 2 肝动脉相关指数对老年PLC患者治疗效果预测的ROC图
Figure 2. ROC diagram of hepatic artery related index for predicting the therapeutic effect of elderly patients with PLC.
表 1 对比无效组和有效组患者的临床资料
Table 1. Comparison of clinical data of patients in ineffective group and effective group[n(%)]
可能影响因素 无效组（n=58） 有效组（n=178） χ2/t P 性别（男） 48（82.76） 135（75.84） 1.202 0.273 年龄（岁, Mean±SD） 76.53±7.15 74.68±7.03 1.733 0.084 BMI（kg/m2, Mean±SD） 22.18±3.11 22.55±3.25 0.761 0.448 肝功能child分级 5.626 0.018 A级 28（48.28） 117（65.73） B级 30（51.72） 61（34.27） 肿瘤直径（cm, Mean±SD） 5.21±1.17 3.85±1.02 8.498 < 0.001 吸烟史 29（46.55） 68（38.20） 1.268 0.260 饮酒史 22（37.93） 54（30.34） 1.155 0.282 合并高血压 18（31.03） 43（24.16） 1.079 0.299 合并糖尿病 17（29.31） 42（23.60） 0.762 0.383 合并高血脂症 23（39.66） 57（32.02） 1.137 0.286 合并肝硬化 48（82.76） 137（76.97） 0.866 0.352 病理分型 10.068 0.002 中/高分化 19（32.76） 101（56.74） 低分化 39（67.24） 77（43.26） BCLC分期 7.783 0.005 A/B期 40（68.97） 152（85.39） C期 18（31.03） 26（14.61） 肿瘤数目 4.032 0.045 单发 40（68.97） 145（81.46） 多发 18（31.03） 33（18.54） TACE治疗次数（Mean±SD） 3.08±0.86 2.85±0.82 1.833 0.068 肝动脉直径（cm, Mean±SD） 0.37±0.09 0.35±0.08 1.602 0.110 RI（Mean±SD） 0.87±0.13 0.85±0.11 1.148 0.252 DPI（Mean±SD） 0.48±0.13 0.45±0.11 1.723 0.086 PSV（cm/s, Mean±SD） 91.32±14.35 78.21±12.87 6.546 < 0.001 PI（Mean±SD） 1.84±0.46 1.52±0.34 5.677 < 0.001 BCLC：巴塞罗那分期；TACE：肝动脉化疗栓塞；RI：阻力指数；DPI：血流灌注指数；PSV：肝动脉收缩期峰值；PI：搏动指数. 
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表 2 自变量赋值
Table 2. Assignment of independent variables
自变量 赋值 自变量 赋值 肝功能child分级 A级=0，B级=1 肿瘤数目 单发=0，多发=1 肿瘤直径 连续变量 PSV 连续变量 病理分型 中/高分化=0，低分化=1 PI 连续变量 BCLC分期 A/B期=0，C期=1
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表 3 影响老年PLC患者TACE治疗效果的多因素Logistic回归分析
Table 3. Multivariate logistic regression analysis of the effects of TACE treatment in elderly patients with PLC
因素 β SE Wald χ2 P OR 95%CI 病理分型 1.389 0.368 14.247 < 0.001 4.011 2.150~7.481 PSV 1.206 0.415 8.445 0.011 3.340 1.254~6.084 PI 1.032 0.446 5.354 0.015 2.807 1.052~5.436
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表 4 肝动脉相关指数对老年PLC患者治疗效果预测的ROC分析
Table 4. ROC analysis of hepatic artery related index for predicting the therapeutic effect of elderly patients with PLC
检测指标 最佳截断点 敏感度（%） 特异性（%） AUC 95%CI PSV（cm/s） 82.42 79.31（46/58） 67.42（120/178） 0.772 0.713~0.824 PI 1.73 63.79（37/58） 83.71（149/178） 0.753 0.693~0.807
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表 5 预后良好组和预后不良组肝动脉相关指数对比
Table 5. Comparison of hepatic artery related indexes between the good prognosis group and the poor prognosis group (Mean±SD)
指标 预后不良组（n=72） 预后良好组（n=164） χ2/t P 肝动脉直径（cm） 0.38±0.17 0.34±0.15 1.810 0.072 RI 0.75±0.16 0.73±0.13 1.012 0.313 DPI 0.48±0.13 0.45±0.11 1.823 0.070 PSV（cm/s） 94.36±13.25 75.76±10.25 11.436 < 0.001 PI 2.26±0.63 1.77±0.38 7.373 < 0.001
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