Correlation between Arterial Enhancement Fraction on CT and Efficacy of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma
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摘要: 目的：探讨CT动脉增强分数（AEF）与肝癌经导管动脉化疗栓塞（TACE）治疗效果的相关性。方法：对我院2019年1月至2020年1月43例原发性肝细胞癌（HCC）患者临床资料进行回顾性分析，所有患者均接受TACE治疗，术前及术后1个月均行CT动态增强扫描检查，根据治疗效果分为治疗有效组及无效组，采用电化学发光法检测各组甲胎蛋白（AFP）水平，比较两组治疗前后AEF、AFP、肿瘤大小变化；采用Pearson系数探究AEF、AFP与肿瘤大小变化的相关性，采用受试者工作特征曲线（ROC）及曲线下面积（AUC）分析肝脏动态增强扫描联合AEF彩图对TACE疗效的评估价值。结果：有效组治疗后AEF、AFP、肿瘤大小均小于治疗前、无效组；Pearson相关性分析结果显示，TACE治疗后AEF、AFP均与肿瘤大小呈正相关；ROC曲线分析结果显示，肝脏动态增强扫描联合AEF评估TACE疗效的AUC为0.902，明显高于肝脏动态增强扫描及AEF单独评估的0.793和0.771。结论：AEF对TACE治疗效果具有良好的评估价值，联合肝脏动态增强扫描能进一步提高准确度，可作为TACE治疗HCC疗效评估的辅助手段，值得临床推广。Abstract: Objective: To explore the correlation between arterial enhancement fraction (AEF) on Computed Tomography (CT) and the curative effect of Transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods: We enrolled 43 patients who presented with HCC to our hospital between January 2019 and January 2020 and extracted their clinical data. Three-phase contrast-enhanced CT was performed 1 month before and after TACE; based on TACE efficacy, the enrolled patients were divided into the “effective” and “ineffective” groups. The alpha-fetoprotein (AFP) level was determined using electrochemical luminescence. Changes in the AEF, AFP level, and tumor size before and after treatment were compared between the two groups. The correlation among AEF, AFP level, and tumor-size changes was explored using Pearson’s correlation coefficient. Receiver operating characteristic (ROC) curves and the area under these curves (AUCs) were used to determine the evaluation value of dynamic enhanced scanning combined with AEF for TACE efficacy. Results: After TACE, the AEF, AFP level, and tumor size decreased in the effective group and were lower than the corresponding values in the ineffective group. Pearson’s correlation analysis revealed that AEF and the AFP level were positively correlated with the tumor size after TACE. ROC analysis revealed that the AUC for dynamic enhanced scanning combined with AEF for TACE efficacy evaluation was 0.902; this was significantly greater than the AUC of dynamic enhanced scanning (0.793) and AEF (0.771) alone. Conclusion: AEF is a reliable parameter for evaluating the therapeutic effect of TACE. The evaluation of TACE efficacy can be further improved by combining AEF with dynamic enhanced scanning; this approach should be used as an auxiliary method for evaluating TACE efficacy for HCC.
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图 1 肝脏动态增强扫描联合AEF评估TACE疗效的ROC曲线
Figure 1. ROC curve of dynamic enhanced liver scanning combined with AEF for evaluating TACE efficacy
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图 2 HCC患者AEF伪彩图，CT增强扫描动脉期、门脉期及CT平扫图像
Figure 2. CT image with an AEF, CT image taken during the arterial phase, CT image taken during the portal venous phase, and plain CT of a patient with HCC
表 1 两组治疗AEF、AFP、肿瘤大小比较（
$ \bar x \pm s $ ）Table 1 Comparison of the AEF, AFP level and tumor size between the two groups (
$ \bar x \pm s $ )组别 AEF AFP/（ng/L） 肿瘤大小/cm 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 有效组 0.51±0.13 0.34±0.05* 385.12±10.29 84.89±8.39* 6.28±1.05 3.01±0.41* 无效组 0.52±0.09 0.48±0.07 382.87±21.54 373.25±17.82 6.05±1.13 5.96±1.05 t 0.265 7.594 0.420 72.436 0.667 13.209 P 0.792 0.000 0.676 0.000 0.509 0.000 注：与本组治疗前，*-P＜0.05。 
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表 2 AEF、AFP与肿瘤大小的相关性
Table 2 Correlation between the AEF, AFP level and tumor size
指标 肿瘤大小 P AEF 0.537 0.002 AFP 0.649 0.000
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表 3 肝脏动态增强扫描联合AEF对TACE疗效的评估价值
Table 3 Evaluation value of dynamic enhanced liver scanning combined with AEF for TACE efficacy
项目 AUC P 95％ CI 肝脏动态增强扫描 0.793 ＜0.05 0.642～0.901 AEF 0.771 ＜0.05 0.618～0.885 肝脏动态增强扫描联合AEF 0.902 ＜0.05 0.773～0.972
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