CT灌注成像参数及血清癌胚抗原和甲胎蛋白在监测原发性肝癌TACE术后复发中的应用

doi:10.3969/j.issn.1006-5725.2026.02.002

Abstract

Abstract:

Objective To investigate the application of CT perfusion （CTP） parameters， carcinoembryonic antigen （CEA）， and alpha-fetoprotein （AFP） in monitoring recurrence after transcatheter arterial chemoembolization （TACE） in patients with primary hepatocellular carcinoma （HCC）. Methods A retrospective analysis was conducted on 203 HCC patients who underwent TACE at the hospital from September 2022 to September 2023. CTP parameters ［blood flow （BF）， blood volume （BV）， hepatic arterial perfusion index （HAI）， portal venous perfusion （PVP）］， CEA， and AFP levels were measured before and one month after TACE. Patients were followed up for one year and divided into recurrence and non-recurrence groups based on tumor status. Differences in BF， BV， HAI， PVP， CEA， and AFP levels between the two groups were compared. Receiver operating characteristic （ROC） curves were plotted to evaluate the predictive value of these indicators for post-TACE recurrence， and logistic regression was used to analyze influencing factors. Results Compared with pre-TACE levels， BF， BV， HAI， CEA， and AFP decreased one month after TACE， while PVP increased （P < 0.05）. Among the 203 patients， 75 （36.95%） experienced recurrence， while 128 （63.05%） remained recurrence-free. Compared with the non-recurrence group， the recurrence group exhibited higher BF， BV， HAI， CEA， and AFP levels and lower PVP （P < 0.05）. The AUC values for BF， BV， HAI， PVP， CEA， and AFP in predicting recurrence were 0.771， 0.787， 0.787， 0.735， 0.771， and 0.795， respectively. The combined detection of these indicators yielded an AUC of 0.968 （P < 0.05）. Logistic regression identified BF， BV， HAI， PVP， CEA， and AFP as independent risk factors for post-TACE recurrence （P < 0.05）. Conclusion CTP combined with serum tumor markers can effectively predict early recurrence in HCC patients after TACE.

Key words: primary hepatocellular carcinoma, transcatheter arterial chemoembolization, CT perfusion imaging, carcinoembryonic antigen, alpha-fetoprotein, recurrence, influencing factors

CLC Number:

R735.7

Pengzheng LI,Baoguo CHENG,Jinzhan LIU,Weixing LI. Application of CT perfusion parameters and serum CEA/AFP in monitoring post-TACE recurrence in primary hepatocellular carcinoma[J]. The Journal of Practical Medicine, 2026, 42(2): 176-184.

Figures/Tables 9

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References 31

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时间	BF/［mL/（min·100 mL）］	BV/（mL/100 mL）	HAI	PVP/［mL/（min·100 mL）］	CEA/（ng/mL）	AFP/（ng/mL）
术前（n = 203）	178.85 ± 50.00	25.67 ± 6.48	0.54 ± 0.11	21.67 ± 4.58	16.58 ± 5.00	485.23 ± 110.45
术后1个月（n = 203）	118.43 ± 20.41	21.00 ± 5.13	0.40 ± 0.10	43.19 ± 7.14	6.60 ± 0.75	50.70 ± 2.33
t值	15.940	8.051	13.418	36.146	28.124	56.041
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	BF/［mL/（min·100 mL）］	BV/（mL/100 mL）	HAI	PVP/［mL/（min·100 mL）］	CEA/（ng/mL）	AFP/（ng/mL）
复发组（n = 75）	161.22 ± 35.45	26.13 ± 8.00	0.55 ± 0.12	20.30 ± 7.14	10.13 ± 2.99	101.56 ± 33.15
未复发组（n = 128）	93.35 ± 12.00	18.00 ± 4.56	0.31 ± 0.07	56.60 ± 15.45	4.53 ± 0.41	20.90 ± 3.56
t值	19.836	9.229	18.010	19.697	20.892	27.308
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

指标	截断值	AUC	约登指数	敏感度/%	特异度/%	95%CI	P值
BF	110.62 mL/（min·100 mL）	0.771	0.461	68.00	78.12	0.707 ~ 0.827	< 0.001
BV	22.83 mL/100 mL	0.787	0.522	69.33	82.81	0.724 ~ 0.841	< 0.001
HAI	0.38	0.787	0.421	73.33	68.75	0.725 ~ 0.841	< 0.001
PVP	38.00 mL/（min·100 mL）	0.735	0.361	72.00	64.06	0.609 ~ 0.795	< 0.001
CEA	4.98 ng/mL	0.771	0.476	86.67	60.94	0.707 ~ 0.827	< 0.001
	29.02 ng/mL	0.795	0.516	77.33	74.22	0.733 ~ 0.848	< 0.001
联合	/	0.968	0.830	94.67	88.28	0.934 ~ 0.988	< 0.001

临床资料	复发组（n = 75）	未复发组（n = 128）	χ² 值	P值
年龄			0.338	0.561
< 50岁	32（42.67）	60（46.88）
≥ 50岁	43（57.33）	68（53.12）
性别			0.298	0.585
男	41（54.67）	75（58.59）
女	34（45.33）	53（41.41）
乙肝史	46（61.33）	78（60.94）	0.003	0.955
肿瘤最大径			0.292	0.589
< 5 cm	44（58.67）	80（62.50）
≥ 5 cm	31（41.33）	48（37.50）
肿瘤数目			0.076	0.782
单发	36（48.00）	64（50.00）
多发	39（52.00）	64（50.00）
肝功能Child-Pugh分级			0.031	0.861
A级	32（42.67）	53（41.41）
B级	43（57.33）	75（58.59）
肿瘤分期			2.832	0.243
Ⅱa期	20（26.67）	46（35.94）
Ⅱb期	31（41.33）	53（41.41）
Ⅲa期	24（32.00）	29（22.65）
分化程度			1.719	0.190
中高分化	52（69.33）	77（60.16）
低分化	23（30.67）	51（39.84）
门静脉癌栓
术后1个月BF			13.481	< 0.001
< 110.62 mL/（min·100 mL）	20（26.67）	68（53.13）
≥ 110.62 mL/（min·100 mL）	55（73.33）	60（46.87）
术后1个月BV			5.331	0.021
< 22.83 mL/100 mL	35（46.67）	81（63.28）
≥ 22.83 mL/100 mL	40（53.33）	47（36.72）
术后1个月HAI			6.771	0.009
< 0.38	28（37.33）	72（56.25）
≥ 0.38	47（62.67）	56（43.75）
术后1个月PVP			15.849	< 0.001
< 38.00 mL/（min·100 mL）	48（64.00）	45（35.16）
≥ 38.00 mL/（min·100 mL）	27（36.00）	83（64.84）
术后1个月CEA			4.348	0.037
< 4.98 ng/mL	32（42.67）	74（57.81）
≥ 4.98 ng/mL	43（57.33）	54（42.19）
术后1个月AFP			52.647	< 0.001
< 29.02 ng/mL	12（16.00）	88（68.75）
≥ 29.02 ng/mL	63（84.00）	40（31.25）

变量	赋值
术后1个月BF	< 110.62 mL/（min·100 mL） = 0；≥ 110.62 mL/（min·100mL） = 1
术后1个月BV	< 22.83 mL/100 mL = 0；≥ 22.83 mL/100 mL = 1
术后1个月HAI	< 0.38 = 0；≥ 0.38 = 1
术后1个月PVP	≥ 38.00 mL/（min·100 mL） = 0；< 38.00 mL/（min·100 mL） = 1
术后1个月CEA	< 4.98 ng/mL= 0；≥ 4.98 ng/mL = 1
术后1个月AFP	< 29.02 ng/mL = 0；≥ 29.02 ng/mL = 1

Application of CT perfusion parameters and serum CEA/AFP in monitoring post-TACE recurrence in primary hepatocellular carcinoma

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指标	β	SE	Wald χ²	OR	95%CI	P值
术后1个月BF	0.335	0.126	7.069	1.398	1.092 ~ 1.790	0.008
术后1个月BV	0.279	0.103	7.337	1.322	1.080 ~ 1.617	0.007
术后1个月HAI	0.321	0.118	7.400	1.379	1.094 ~ 1.737	0.007
术后1个月PVP	0.295	0.113	6.815	1.343	1.076 ~ 1.676	0.009
术后1个月CEA	0.321	0.142	5.110	1.379	1.044 ~ 1.821	0.024
术后1个月AFP	0.398	0.122	10.643	1.489	1.172 ~ 1.891	0.001

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