肾透明细胞癌侵袭性与CT强化特征相关性研究

发布时间：2018-05-13 05:26

  本文选题：肾细胞癌 + 透明细胞癌　； 参考：《上海交通大学》2015年博士论文

【摘要】：目的:建立肾脏肿瘤在增强CT图像上强化程度的测量方法,研究肾透明细胞癌强化特征与肿瘤Fuhrman分级的关系。对象和方法:回顾性分析255例住院接受肾癌根治术或肾脏部分切除术的肾透明细胞癌患者,获取其临床一般资料、多期增强CT图像和手术标本病理检查结果。在增强CT图像上测量、记录相关影像学特征及参数,包括肿瘤最大径、肿瘤强化特征、是否存在肿瘤内钙化、是否为囊性病灶、肿瘤边缘光整度等。建立肾脏肿瘤强化程度的测量方法,定义代表强化程度的四个指标(TEV1、REV1、TEV2、REV2),研究强化指标与肾透明细胞癌Fuhrman分级之间的关系及其对后者的预测。将影像学特征、参数以及相关临床一般资料纳入多因素分析,寻找与肿瘤高Fuhrman分级相关的独立因素。前瞻性纳入45例透明细胞癌患者对前述所得结论进行验证。结果:255例肾透明细胞癌患者中位年龄59岁,其中男性196例(76.9%),女性59例(23.1%),肿瘤最大径中位数4.4cm。Fuhrman分级1-4级分别为24例(9.4%)、188例(73.7%)、40例(15.7%)、3例(1.2%)。四个强化指标在不同Fuhrman分级之间存在显著的组间差异(p0.001),随着Fuhrman分级升高,四个强化指标均呈现下降趋势。高级别(Fuhrman 3-4级)透明细胞癌的TEV1、REV1、TEV2、REV2值均显著低于低级别(Fuhrman 1-2级)透明细胞癌(p0.001)。使用强化指标对肿瘤Fuhrman分级的高低进行预测,ROC曲线图中TEV1、REV1、TEV2、REV2的曲线下面积分别为0.882、0.926、0.847、0.871。以0.65为临界值,REV1对高Fuhrman分级预测的敏感度和特异度分别为0.84、0.93。将REV1值与其他临床、影像学变量纳入多因素分析,作为肿瘤Fuhrman分级高低的预测因素,logistic回归显示,患者高龄、肿瘤边缘不规则和低REV1值为肿瘤高Fuhrman分级的独立预测因素。在验证队列中,REV1≤0.65对高Fuhrman分级预测的敏感度和特异度分别为0.83、0.87。结论:肾透明细胞癌在增强CT上的强化程度与Fuhrman分级呈负相关,患者高龄、肿瘤边缘不规则以及肿瘤低强化,构成肾透明细胞癌高Fuhrman分级的独立预测因素。该评估方法有助于肾脏肿瘤的侵袭性评估,对临床决策可能具有指导意义。
[Abstract]:Objective: to study the relationship between enhancement characteristics of renal clear cell carcinoma and Fuhrman grade of renal tumor. Participants and methods: 255 cases of renal clear cell carcinoma who underwent radical nephrectomy or partial nephrectomy were retrospectively analyzed. The clinical data, multiphase enhanced CT images and pathological findings of the specimens were obtained. The imaging features and parameters were recorded on enhanced CT images, including tumor maximum diameter, tumor enhancement, calcification in tumor, cystic lesion, margin light integration and so on. To establish a method to measure the degree of enhancement of renal tumors, and to define four indicators representing the degree of enhancement: TEV1 / REV1 / TEV2 / REV2. To study the relationship between enhancement and Fuhrman grade of renal clear cell carcinoma (RCC) and the prediction of the latter. Imaging features, parameters and general clinical data were included in multivariate analysis to find the independent factors associated with high Fuhrman grade of tumor. A prospective study of 45 patients with clear cell carcinoma was performed to verify the above conclusions. Results the median age of 255 cases of renal clear cell carcinoma was 59 years old. Among them, 196 cases were male (76. 9%) and 59 cases were female (23. 1%). The median 4.4cm.Fuhrman grade 1-4 of the median diameter of the tumor was 24 cases (9. 4%) respectively. There were significant differences among the four enhancement indexes among different Fuhrman grades, and with the increase of Fuhrman grading, the four enhancement indexes showed a downward trend. The values of TEV1, REV1, TEV2 and REV2 were significantly lower than those of low grade Fuhrman 1-2) of clear cell carcinoma (P 0.001). The area under the curve of TEV1 / REV1 / TEV2 / REV2 was 0.8820.92 / 0.926 / 0.847 / 0.871respectively, using the enhancement index to predict the level of tumor Fuhrman grade in the curve of TEV1 / REV1 / TEV2REV2 / REV2 / REV2 / REV2, respectively. The sensitivity and specificity of 0. 65 as the critical value for high Fuhrman grade prediction were 0. 84 and 0. 93 respectively. REV1 and other clinical and imaging variables were included in the multivariate analysis. As a predictor of tumor Fuhrman grade, the elderly patients, irregular tumor margin and low REV1 were independent predictors of high Fuhrman grade. In the validation cohort, the sensitivity and specificity of REV1 鈮，

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