多层螺旋CT在进展期胃癌术前化疗临床疗效评估意义的研究

发布时间：2018-09-09 20:13

【摘要】：目的：尽管近年来胃癌的发病率有下降趋势，但胃癌仍是死亡率较高的常见肿瘤，这与患者确诊时肿瘤分期较晚有关。近期国内、外的研究表明进展期胃癌术前化疗可使肿瘤降期，有效提高手术切除率和生存时间。而术前客观、准确的疗效评价对选择下一步治疗方案和预后推断至关重要。目前，对于胃癌术前化疗疗效评价缺乏统一的标准，临床上多应用胃癌T、N、M分期的变化，或RECIST疗效评价标准，计算化疗前后肿瘤最长径的变化对疗效评价。值得注意的是，多层螺旋CT（Multislice SpiralComputed Tomography，MSCT）对于N分期的准确性并不理想，其对化疗后T分期的准确率也有所降低。胃癌分型、胃的蠕动、胃腔充盈程度及瘤体化疗后自身的变化影响长径测量的准确性。随着多层螺旋CT各种后处理技术、软件的不断开发，通过软件可对胃肿瘤的密度、厚度及体积进行测量，在进展期胃癌术前化疗疗效的评估中显示出越来越多的优势。国内、外对CT测量肿瘤体积、密度、厚度评价进展期胃癌术前化疗疗效的研究较少。本研究采用多层螺旋CT对进展期胃癌术前化疗前后进行增强扫描，记录CT测量肿瘤体积、密度及厚度的变化，通过与RECIST疗效评价标准对比，讨论多层螺旋CT扫描在进展期胃癌患者术前化疗疗效评价中的应用,初步找出进展期胃癌术前化疗疗效评价的最佳联合指标。数据用SPSS13.0统计学软件处理，P＜0.05认为差异具有统计学意义。方法：收集2010年12月至2013年1月在河北省肿瘤医院经胃镜咬检病理证实的胃癌患者89例，其中男性66例，女性23例，年龄31～78岁，平均年龄57.51±10.96岁。均行MSCT增强扫描，影像学评估为T3、T4期且为M0，既往未经化疗治疗，且无明显化疗禁忌。术前给予化疗（Xelox或SOX）2-3个疗程，化疗结束后1周内再行MSCT增强扫描评估。分别测量化疗前与化疗后肿瘤的总最长径、体积、密度及厚度，计算化疗前后各数据的变化。依据RECIST1.1标准对术前化疗疗效进行评价，将化疗后疗效分为完全缓解(Complete Remission,CR)、部分缓解（PartlyRemission,PR）、稳定（Stable disease,SD）、进展（Progression disease,PD），其中CR、PR归为有效组，SD、PD归为无效组。各测量数据进行统计学分析，与RECIST疗效评价行相关性分析，应用接受者操作特征曲线（receiver operating characteristic curve，ROC曲线），试图找出MSCT增强扫描在进展期胃癌化疗疗效评价中最佳的指标，确定其最佳阈值及其敏感性和特异性。结果： 1化疗有效组与无效组之间平均年龄差异无统计学意义（P=0.941）。 2化疗有效组与无效组之间性别差异无统计学意义（P=0.617）。 3化疗后肿瘤密度（69.61±14.59HU）较化疗前肿瘤密度（77.48±15.17HU）减小（P=0.000）；化疗后肿瘤体积（71.2±52.45cm3）较化疗前肿瘤体积（78.07±50.33cm3)减小（P=0.033）；化疗后肿瘤厚度（13.25±3.58mm）较化疗前（14.58±4.28mm）减小（P=0.006）,三者差异均有统计学意义。 4化疗有效组和无效组肿瘤密度减小率分别为18.73%±14.78%和11.34%±9.31%（P=0.024），差异有统计学意义；化疗有效组和无效组体积减小率分别为36.51%±12.24%和12.57%±9.16%（P=0.01），差异有统计学意义；化疗有效组和无效组肿瘤厚度减小率分别为14.58±4.28%和7.4%±5.92%（P=0.201），，还不能说明两组间差异有统计学意义。 5CT肿瘤体积减小率与RECIST疗效评价的相关性r=0.547（P=0.001）,呈中度相关。CT肿瘤密度减小率与RECIST疗效评价的相关性r=0.36（P=0.013）,呈低度相关。 6化疗前后肿瘤体积减小率曲线下面积0.907（0.784～1.031），如果将肿瘤体积减少率11.73%作为评价术前化疗有效的阈值，其预测胃肿瘤最长径减少率评价化疗有效的敏感度是100%，特异性66.7%。结论： 1. MSCT增强扫描肿瘤密度、体积减小率可以帮助评估进展期胃癌化疗的疗效。 2. MSCT增强扫描肿瘤体积减小率对进展期胃癌化疗疗效的评价优于密度减小率。 3.如果将肿瘤体积减小率11.73%作为评价化疗有效的阈值，其预测肿瘤最长径减小率评价化疗有效的敏感度是100%，特异性66.7%。
[Abstract]:Objective: Despite the decreasing incidence of gastric cancer in recent years, gastric cancer is still a common tumor with a high mortality rate, which is related to the late staging of the tumor when the patient is diagnosed. At present, there is no uniform standard for evaluating the curative effect of preoperative chemotherapy for gastric cancer. T, N, M stages or RECIST criteria are often used to evaluate the curative effect of preoperative chemotherapy for gastric cancer. Gastric cancer typing, gastric peristalsis, gastric cavity filling and changes in tumor itself after chemotherapy affect the accuracy of length measurement. With the development of various post-processing techniques of multi-slice spiral CT, software has been developed. The software can be used to measure the density, thickness and volume of gastric tumors, showing more and more advantages in the evaluation of preoperative chemotherapy efficacy for advanced gastric cancer.
In this study, multi-slice spiral CT (MSCT) was used to contrast the volume, density and thickness of advanced gastric cancer before and after preoperative chemotherapy. The application of MSCT in preoperative chemotherapy evaluation of advanced gastric cancer was discussed by comparing with RECIST. The data were processed by SPSS13.0 statistical software, and the difference was statistically significant (P<0.05).
Methods: From December 2010 to January 2013, 89 patients with gastric cancer, including 66 males and 23 females, aged 31-78, with an average age of 57.51 [10.96], who were confirmed by gastroscopic biopsy in Hebei Cancer Hospital, underwent enhanced MSCT scan. All patients were evaluated as T3, T4 and M0 by imaging. They had not received chemotherapy before and had no obvious contraindication of chemotherapy. Before chemotherapy (Xelox or SOX) 2-3 courses, after chemotherapy within one week after the end of MSCT enhanced scan evaluation. Chemotherapy before and after the total tumor diameter, volume, density and thickness were measured, calculated before and after the changes in the data before and after chemotherapy. According to RECIST 1.1 standard, preoperative chemotherapy efficacy was evaluated, the efficacy after chemotherapy was divided into complete remission (CR). Complete Remission, CR, PR, Stable Disease, Progression Disease (PD), CR, PR were classified as effective group, SD, PD were classified as ineffective group. By using ristic curve and ROC curve, we try to find out the best index of MSCT enhanced scan in evaluating the curative effect of advanced gastric cancer chemotherapy, and determine the best threshold, sensitivity and specificity.
Result:
1 there was no significant difference in mean age between the effective group and the invalid group (P=0.941).
2 there was no significant difference in sex between the effective group and the invalid group (P=0.617).
3 Tumor density (69.61 + 14.59 HU) after chemotherapy was significantly lower than that before chemotherapy (77.48 + 15.17 HU) (P = 0.000); tumor volume (71.2 + 52.45 cm 3) after chemotherapy was significantly lower than that before chemotherapy (78.07 + 50.33 cm 3) (P = 0.033); tumor thickness (13.25 + 3.58 mm) after chemotherapy was significantly lower than that before chemotherapy (14.58 + 4.28 mm) (P = 0.006). Significance.
4 The tumor density reduction rates of the effective group and the ineffective group were 18.73% + 14.78% and 11.34% + 9.31% (P = 0.024), respectively, and the difference was statistically significant. The volume reduction rates of the effective group and the ineffective group were 36.51% + 12.24% and 12.57% + 9.16% (P = 0.01), respectively. 14.58 + 4.28% and 7.4% + 5.92% (P=0.201) did not indicate that the difference between the two groups was statistically significant.
The correlation between tumor volume reduction rate and RECIST efficacy was moderately correlated (r = 0.547, P = 0.001). The correlation between tumor density reduction rate and RECIST efficacy evaluation was low (r = 0.36, P = 0.013).
6. The area under the curve of tumor volume reduction rate before and after chemotherapy was 0.907 (0.784-1.031). If the tumor volume reduction rate was 11.73% as the threshold to evaluate the effectiveness of preoperative chemotherapy, the sensitivity and specificity of predicting the longest diameter reduction rate of gastric tumor for evaluating the effectiveness of chemotherapy were 100% and 66.7% respectively.
Conclusion:
1. MSCT enhanced scan density and volume reduction rate can help evaluate the efficacy of chemotherapy for advanced gastric cancer.
2. The tumor volume reduction rate of MSCT enhanced scan is superior to the density reduction rate in evaluating the efficacy of chemotherapy for advanced gastric cancer.
3. If the tumor volume reduction rate was 11.73% as the threshold for evaluating the effectiveness of chemotherapy, the sensitivity and specificity of predicting the maximum diameter reduction rate for evaluating the effectiveness of chemotherapy were 100% and 66.7% respectively.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R735.2;R816.5

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