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目的分析肝细胞癌的生物学特性、所生成的肿瘤标记物和钆塞酸增强MR影像中信号强度的相关性。材料与方法本回顾性研究获得单位伦理委员会批准和病人的知情同意。收集2008年4月—2011年9月的180例手术切除肝癌的病人[男138例,女42例;年龄34～83岁,平均(65±10.3)岁]资料,根据其在钆塞酸增强MR影像肝胆期时相对于背景肝实质的信号强度分为低信号组(n=158)和高信号组(n=22)。通过血清学和免疫组化染色,比较和分析其病理学特征,甲胎蛋白和维生素K缺乏所产生的蛋白或PIVKA-II产物情况。同时评估其复发和生存率。采用Mann-Whitney和Pearson相关性检验进行统计学分析。结果高信号肝细胞癌(13.6%)较低信号者(36.7%)的分化程度高(P=0.028),门静脉侵犯的概率低(P=0.039)。高信号肝细胞癌较低信号者的血清甲胎蛋白水平、甲胎蛋白的扁豆凝集素结合活性和PIVKA-Ⅱ水平均表现减低(P值分别为0.003,0.004和0.026)。免疫组化显示,高信号肝细胞癌的甲胎蛋白和PIVKA-Ⅱ表达均低于低信号者(均P<0.001)。高信号肝细胞癌的复发率低于低信号者(P=0.039)。结论结果提示,钆塞酸增强MR影像中高信号肝细胞癌的侵犯程度低于低信号的肝细胞癌。
OBJECTIVE: To analyze the biological characteristics of hepatocellular carcinoma (HCC) and the correlation between the tumor markers generated and the signal intensity of gadoxate-enhanced MR images. Materials and Methods This retrospective study was approved by the Unit Ethics Committee and patient informed consent. A total of 180 patients with HCC who underwent surgical resection between April 2008 and September 2011 [138 males and 42 females, aged 34-83 years (mean, 65 ± 10.3 years)] were enrolled in this study, The signal intensity of MR images in hepatobiliary stage relative to background liver parenchyma was divided into low signal group (n = 158) and high signal group (n = 22). Serological and immunohistochemical staining was used to compare and analyze the pathological features of the protein or PIVKA-II product produced by alpha-fetoprotein and vitamin K deficiency. At the same time to assess its recurrence and survival rate. Statistical analyzes were performed using Mann-Whitney and Pearson correlation tests. Results Highly differentiated hepatocellular carcinoma (13.6%) had a higher degree of differentiation (36.7%) (P = 0.028) and a lower probability of portal vein invasion (P = 0.039). Serum alpha-fetoprotein levels, alpha-fetoprotein lentilid binding activity, and PIVKA-II levels were all significantly lower in patients with higher signal hepatocellular carcinoma than in those with lower signal (P values 0.003, 0.004, and 0.026, respectively). Immunohistochemistry showed that the expression of alpha-fetoprotein and PIVKA-II in high signal hepatocellular carcinoma was lower than that in low signal (all P <0.001). The recurrence rate of high-grade hepatocellular carcinoma was lower than that of low-grade ones (P = 0.039). Conclusions The results suggest that the extent of hypersensitive hepatocellular carcinoma in gadolinium-enhanced MR images is lower than that in low-signal hepatocellular carcinomas.