Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child...Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child-Turcotte Pugh(CTP)on patients’overall survival(OS).Methods:A retrospective analysis was conducted on 43 HCC patients at a single oncology center in Saudi Arabia from 2015 to 2020.All patients had to fulfill one of the following criteria:(a)a liver lesion reported as definitive HCC on dynamic imaging and/or(b)a biopsy-confirmed diagnosis.Results:The mean patient age of all HCC cases was 66.8 with a male-to-female ratio of 3.3:1.All patients were stratified into two groups:viral HCC(n=22,51%)and non-viral HCC(n=21,49%).Among viral-HCC patients,55%were due to HBV and 45%due to HCV.Cirrhosis was diagnosed in 79%of cases.Age and sex did not significantly statistically differ in OS among viral and non-viral HCC patients(p-value>0.05).About 65%of patients had tumor size>5 cm during the diagnosis,with a significant statistical difference in OS(p-value=0.027).AFP was>400 ng/ml in 45%of the patients.There was a statistically significant difference in the OS in terms of AFP levels(p-value=0.021).A statistically significant difference was also observed between the CTP score and OS(p-value=0.02).CTP class B had the longest survival.BSC was the most common treatment provided to HCC patients followed by sorafenib therapy.There was a significant statistical difference in OS among viral and non-viral HCC patients(p-value=0.008).Conclusions:The most common predictors for OS were the underlying cause of HCC,AFP,and tumor size.Being having non-viral etiology,a tumor size>5 cm,an AFP>400 ng/mL,and a CTP score class C were all negatively associated with OS.展开更多
背景肝脏肿瘤性质的无创鉴别是当前临床面临的难题.超声造影(contrast-enhanced ultrasounds,CEUS)和血清甲胎蛋白(alpha-fetoprotein,AFP)/总胆汁酸(total bile acid,TBA)各具优势,但联合诊断价值尚不明确,本研究假设二者联合可提高肝...背景肝脏肿瘤性质的无创鉴别是当前临床面临的难题.超声造影(contrast-enhanced ultrasounds,CEUS)和血清甲胎蛋白(alpha-fetoprotein,AFP)/总胆汁酸(total bile acid,TBA)各具优势,但联合诊断价值尚不明确,本研究假设二者联合可提高肝脏肿瘤无创鉴别诊断效能,并与病理结果一致.目的研究CEUS联合血清AFP/TBA鉴别肝血管瘤、原发性肝癌及肝转移瘤与病理活检的一致性.方法选取2023-07/2025-03杭州市临安区第四人民医院收治的291例肝脏肿瘤患者作为研究对象,建立CEUS联合血清AFP/TBA的鉴别诊断模型,其中经组织病理确诊恶性198例(原发性肝癌135例,肝转移瘤63例)为恶性组,良性93例(肝血管瘤)为良性组.另选本中心2025-04/2025-06,124例肝脏肿瘤(组织病理学提示恶性88例,良性36例)患者作为外部验证数据.比较2组常规超声表现、CEUS结果及血清AFP/TB,构建Logistic回归模型分析恶性病变的影响因素,使用受试者工作特征(receiver operating characteristic,ROC)曲线分析CEUS、血清AFP/TBA单独及联合应用在病灶性质鉴别诊断中的价值,并采用ROC曲线、一致性分析对联合诊断效能进行内、外部评价.结果恶性组形态不规则占比、边界不清晰占比、内部回声不均匀占比、病灶及周围血流信号Ⅱ级+Ⅲ级占比、增强速率及血清AFP/TBA分别为32.83%、46.46%、60.10%、91.92%、(0.85±0.19)、(6.07±2.02),显著高于良性组20.43%、31.18%、24.73%、19.33%、(0.57±0.16)、(1.64±0.53),50%倾斜率、达峰时间分别为(0.59±0.12)、(35.40±7.62),显著低于良性组(0.80±0.24)、(44.93±10.51),差异均有统计学意义(P<0.05);Logistic回归模型分析显示,形态不规则、边界不清晰、内部回声不均匀、病灶及周围血流信号Ⅱ级+Ⅲ级、增强速率、血清AFP/TBA是恶性病变的危险因素,50%倾斜率、达峰时间是其保护因素(P<0.05);ROC曲线分析显示,CEUS联合血清AFP/TBA鉴别诊断病灶性质的曲线下面积为0.928,内、外部评价结果显示,净改善了86.50%的分类正确率及对病灶性质的区分能力(均P<0.001);一致性分析发现,CEUS与血清AFP/TBA鉴别诊断结果与病理活检结果一致性好(Kappa=0.819)(P<0.001).结论CEUS联合血清AFP/TBA对肝血管瘤、原发性肝癌及肝转移瘤具有一定鉴别诊断价值,且与病理活检结果具有良好一致性,可为临床无创鉴别诊断肝脏肿瘤性质提供参考,并可指导后续临床决策.展开更多
文摘Background:Hepatocellular carcinoma(HCC)is the most common cause of cancer-related death in Saudi Arabia.Our study aimed to investigate the patterns of HCC and the effect of TNM staging,Alfa-fetoprotein(AFP),and Child-Turcotte Pugh(CTP)on patients’overall survival(OS).Methods:A retrospective analysis was conducted on 43 HCC patients at a single oncology center in Saudi Arabia from 2015 to 2020.All patients had to fulfill one of the following criteria:(a)a liver lesion reported as definitive HCC on dynamic imaging and/or(b)a biopsy-confirmed diagnosis.Results:The mean patient age of all HCC cases was 66.8 with a male-to-female ratio of 3.3:1.All patients were stratified into two groups:viral HCC(n=22,51%)and non-viral HCC(n=21,49%).Among viral-HCC patients,55%were due to HBV and 45%due to HCV.Cirrhosis was diagnosed in 79%of cases.Age and sex did not significantly statistically differ in OS among viral and non-viral HCC patients(p-value>0.05).About 65%of patients had tumor size>5 cm during the diagnosis,with a significant statistical difference in OS(p-value=0.027).AFP was>400 ng/ml in 45%of the patients.There was a statistically significant difference in the OS in terms of AFP levels(p-value=0.021).A statistically significant difference was also observed between the CTP score and OS(p-value=0.02).CTP class B had the longest survival.BSC was the most common treatment provided to HCC patients followed by sorafenib therapy.There was a significant statistical difference in OS among viral and non-viral HCC patients(p-value=0.008).Conclusions:The most common predictors for OS were the underlying cause of HCC,AFP,and tumor size.Being having non-viral etiology,a tumor size>5 cm,an AFP>400 ng/mL,and a CTP score class C were all negatively associated with OS.
