MRI和MSCT对进展期直肠癌新辅助疗效评估价值对比研究

发布时间：2018-03-16 21:14

本文选题：直肠恶性肿瘤　切入点：术前分期　出处：《中华肿瘤防治杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的术前新辅助治疗现在已作为中低位进展期直肠癌的标准治疗模式,对于新辅助之后患者的分期评估尤为重要并且将决定患者的下一步治疗方案。本研究将探讨磁共振成像(magnetic resonance imaging,MRI)及多层螺旋CT(multisliecs helieal CT,MSCT)在评价术前新辅助放疗或同步放化疗(neoadjuvant chemoradiotherapy,NACRT)对中晚期低位直肠癌疗效的应用价值。方法回顾性分析2011-01-01-2015-12-31新疆肿瘤医院经肠镜检查病理活检确诊的145例进展期中低位直肠癌患者,依据标准化NACRT前、后的盆腔MRI及MSCT资料分成实验组(MRI组)和对照组(MSCT组)。分析NACRT前后MRI组和MSCT组上肿瘤的体积、TN分期、环周切缘(circumferential resection margin,CRM)的改变,并与术后病理结果分别进行对照。结果 MRI组NACRT后肿瘤完全缓解4例,部分缓解23例,稳定8例,进展3例,有效率为71.1%;MSCT组NACRT后肿瘤完全缓解16例,部分缓解63例,稳定17例,进展11例,有效率为72.0%,两组有效率比较,差异无统计学意义,χ~2=0.011,P0.05。MRI组术前T分期、CRM受侵情况的判断与术后病理结果一致性较好(Kappa=0.546、0.685),而N分期与术后病理结果一致性较差(Kappa=0.333);MSCT组术前T分期、CRM受累情况的判断与术后病理结果一致性较好(Kappa=0.503、0.650),而N分期与术后病理结果一致性较差(Kappa=0.299)。两组影像学分期分别与术后病理结果进行对照比较:(1)T分期,两组比较差异无统计学意义,χ~2=1.287,P0.05;(2)N分期,两组比较差异无统计学意义,χ~2=0.154,P0.05;(3)CRM受累情况,两组比较差异无统计学意义,χ~2=0.344,P0.05。结论 NACRT可以有效缩小肿瘤的体积,降低肿瘤分期,但对CRM受侵情况并无明显改善。MRI和MSCT可以较为准确的判断肿瘤浸润程度,但对于淋巴结转移的检测准确性较差,MRI的一致性优于MSCT,但准确性无明显差异。
[Abstract]:Objective preoperative neoadjuvant therapy has become the standard mode of treatment for advanced middle and low rectal cancer. This study will explore magnetic resonance imaging (MRI) and multilayer spiral CT(multisliecs helieal CT (MSCT) in the evaluation of preoperative neoadjuvant radiotherapy or simultaneous radiotherapy. The clinical value of neoadjuvant chemotherapy in the treatment of middle and advanced low rectal cancer was analyzed retrospectively. Methods 145 patients with advanced low rectal cancer diagnosed by endoscopy and biopsy in Xinjiang tumor Hospital were retrospectively analyzed. The pelvic MRI and MSCT data before and after standardized NACRT were divided into experimental group and control group. The changes of tumor volume and TN stage and circumferential circumferential resection margin were analyzed before and after NACRT in MRI group and MSCT group. Results there were 4 cases of complete remission, 23 cases of partial remission, 8 cases of stability and 3 cases of progress after NACRT in MRI group. The effective rate was 16 cases of complete remission, 63 cases of partial remission and 17 cases of stability after NACRT in MRI group. There were 11 cases of progress, the effective rate was 72.0 and the effective rate was compared between the two groups. There was no significant difference between the two groups. The difference between preoperative T staging and CRM involvement in MRI group was better than that in Kappa-0.546 ~ 0.685 group, but the difference between N stage and postoperative pathological results was not good. The diagnosis of preoperative T stage CRM involvement in Kappa-0.333 ~ MSCT group was better than that in postoperative pathological results. The consistency of pathological results was better than that of Kappa's 0.503n 0.650, but the N stage was not consistent with the postoperative pathological results 0.299%. The imaging staging of the two groups was compared with the postoperative pathological results, and compared with the pathological results of the two groups, the two groups were compared with the postoperative pathological results, and compared with the postoperative pathological results, the two groups were divided into two groups. There was no statistically significant difference between the two groups, 蠂 ~ (2 +) ~ (2) (1.287) P _ (0.05) ~ (2) N staging, there was no significant difference between the two groups, 蠂 ~ (2 +) (0.154) (P 0.05) was involved, and there was no significant difference between the two groups, 蠂 ~ (2 +) ~ (2) (0.344) P _ (0.05). Conclusion NACRT can effectively reduce the volume of tumor and reduce the tumor stage. However, there was no significant improvement in the invasion of CRM. MRI and MSCT could accurately judge the degree of tumor invasion, but the accuracy of MRI in detecting lymph node metastasis was lower than that of MSCT, but there was no significant difference in accuracy.
【作者单位】：新疆医科大学附属肿瘤医院胃肠外科;
【分类号】：R735.37

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