磁共振波谱评价宫颈癌新辅助化疗疗效的研究

发布时间：2018-04-01 13:21

  本文选题：宫颈癌　切入点：氢质子磁共振波谱　出处：《中南大学》2014年硕士论文

【摘要】：目的 分析宫颈癌新辅助化疗(neoadjuvant chemotherapy, NACT)后质子磁共振波谱(hydrogen proton magnetic resonance spectroscopy,1H-MRS)的特征,探讨其监测宫颈癌NACT疗效的价值。 方法 选择2012年9月-2013年9月中南大学湘雅二医院妇科住院治疗的局部晚期宫颈鳞癌患者15例。每例患者在化疗前、第1次NACT后14天和第2次NACT后14天分别行3次常规磁共振成像(Magnetic Resonance Imaging,MRI)和三维1H-MRS检查。定量分析每例患者MRS中胆碱(Choline, Cho)峰(3.2ppm)、肌酸(Creatine, Cre)峰3.0ppm)、2.0ppm峰(2.0ppm)和脂质(Lipid, Lip)峰(1.4ppm、1.3ppm及0.9ppm)等。每例患者在化疗前、第1次NACT后14天和根治性手术后,分别采用HE染色和免疫组织化学法检测宫颈癌病灶的肿瘤细胞数及Ki-67的表达。2次化疗后评估疗效按最新实体瘤疗效评价标准,以T2加权成像上测量的最长肿块径线为准。 结果 1.15例患者均完成2次NACT。11例化疗有效,4例化疗无效,化疗有效率为73.3%。15例化疗后均行宫颈癌根治性手术治疗。术后补充化疗8例,放化疗7例。 2.15例患者全部成功完成磁共振波谱检查,化疗前后的波谱均可检测到胆碱峰、肌酸峰、2.0ppm峰和脂质峰。化疗有效的宫颈癌胆碱峰值在化疗前、第1次NACT后及第2次NACT后分别为(138.80±63.12)、(81.64±31.61)和(71.27+30.22)；化疗无效的在3个时间点分别为(102.37±24.63)、(104.44±20.01)和(108.06±35.13)。化疗有效的宫颈癌胆碱峰值在第2次和第1次化疗后分别与化疗前相比有显著差异(p=0.006,p=0.000)；化疗无效的在3个不同时间点之间比较无明显差异(p0.05)。肌酸峰、2.0ppm峰和脂质峰值在不同化疗疗效组中和不同时间点之间均无显著差异(p0.05)。 3.化疗有效的宫颈癌胆碱峰下面积在化疗前、第1次NACT后及第2次NACT后分别为(6.30±2.16)、(3.91±0.97)和(3.03±1.38)；化疗无效的在3个时间点分别为(5.34±2.05)、(5.97±2.03)和(5.96±2.18)。化疗有效的宫颈癌胆碱峰下面积在第2次和第1次化疗后分别与化疗前相比有显著差异(p=0.002,p=0.000)；化疗无效的在3个不同时间点无明显差异(p0.05)。肌酸峰、2.0ppm峰和脂质峰下面积在不同化疗疗效组中和不同时间点之间均无显著差异。化疗有效的宫颈癌胆碱与胆酸的峰下面积比(Cho/Cr)在化疗前、第1次及第2次NACT后分别为(2.43+1.19),(2.13+1.01)和(1.17±1.19),Cho/Cr在第2次和第1次化疗后分别与化疗前相比有显著差异(p=0.034,p=0.015)；化疗无效的宫颈癌Cho/Cr在3个不同时间点无明显差异(p0.05)。2.0ppm/Cr、甘油三脂-CH2/Cr、甘油三脂-CH3/Cr和甘油三脂-CH2/-CH3在不同疗效组中的不同时间点比较均无显著性差异(p0.05) 4.在化疗有效的宫颈癌中,第2次NACT后的肿瘤细胞数和ki-67的表达均较化疗前和第1次NACT后显著降低(p0.05)；而在化疗无效组中,化疗前后肿瘤细胞数和ki-67的表达无明显差异(p0.05)。在化疗有效的的宫颈癌中,2次化疗后的Cho峰下面积的变化与ki-67的表达变化呈正相关性(r=0.625,P=0.030; r=0.680, P=0.021);第2次NACT后的Cho峰下面积与化疗前相比的变化与肿瘤细胞数的表达变化呈正相关性(r==0.720,P=0.012)。 结论 1.宫颈癌的1H-MRS可检测到Cho峰、Cr峰、2.0ppm峰和Lip峰。cho峰(包括峰值、峰下面积及cho/Cr匕值)反映了宫颈癌新辅助化疗后肿瘤组织的代谢变化。 2.1H-MRS中的胆碱峰可望应用于评价宫颈癌新辅助化疗的疗效。
[Abstract]:objective
Objective to analyze the characteristics of hydrogen proton magnetic resonance spectroscopy (1H-MRS) after neoadjuvant chemotherapy (NACT) in cervical cancer, and to explore its value in monitoring the efficacy of NACT in cervical cancer.
Method
In September 2012 -2013 year in September in Xiangya No.2 Hospital of Central South University gynecological hospital of 15 patients with locally advanced squamous cell carcinoma of the cervix treated cases. Each patient before chemotherapy, first times 14 days after NACT and second NACT respectively for 14 days after 3 times of conventional magnetic resonance imaging (Magnetic Resonance, Imaging, MRI) and 3D 1H-MRS. Quantitative analysis of choline in each case. In patients with MRS (Choline, Cho) peak (3.2ppm), creatine (Creatine, Cre) 3.0ppm), peak 2.0ppm peak (2.0ppm) and lipid (Lipid, Lip) (1.4ppm, 1.3ppm and 0.9ppm peak). Each patient before chemotherapy, first times 14 days after NACT and after radical operation..2 expression in tumor cells after chemotherapy of cervical cancer lesions detection using HE staining and immunohistochemical method and Ki-67 evaluation of the efficacy evaluation according to the latest clinical criteria in solid tumors, with the longest mass measurement of T2 weighted imaging on the line as the standard.
Result
1.15 patients completed 2 times, NACT.11 chemotherapy was effective, 4 cases were ineffective in chemotherapy, and the effective rate of chemotherapy was 73.3%.15. All patients underwent radical operation of cervical cancer after chemotherapy. 8 cases received postoperative chemotherapy and 7 cases received radiotherapy and chemotherapy.
All 2.15 patients successfully completed the magnetic resonance spectroscopy, spectroscopy before and after chemotherapy were detected in choline, creatine peak, 2.0ppm peak and the lipid peak. Effective chemotherapy of cervical cancer in the choline peak before chemotherapy, first NACT and 2 NACT respectively (138.80 + 63.12), (81.64 + 31.61) and (71.27+30.22); chemotherapy ineffective at 3 time points respectively (102.37 + 24.63), (104.44 + 20.01) and (108.06 + 35.13). Effective chemotherapy of cervical cancer in second choline peak times and first times respectively after chemotherapy and chemotherapy was significant (p= 0.006, p=0.000); therapy between 3 different time points had no significant difference (P0.05). Creatine peak, 2.0ppm peak and the lipid peak had no significant difference in efficacy between different chemotherapy group and different time points (P0.05).
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