首个胰腺癌手术联合静脉重建患者的影像学预后评估系统

发布时间：2018-04-20 19:26

  本文选题：列线图 + 影像学　； 参考：《浙江大学》2017年硕士论文

【摘要】：背景:大多数胰腺癌患者诊断时已处于较晚期阶段,往往伴随有胰周邻近血管侵犯。然而,传统的计算机断层扫描(CT)评价标准主要关注于血管是否受到侵犯,而较少关注患者长期生存预后。因此,我们希望通过建立一个新的有效的基于影像学的评估模型,来预测胰腺癌手术联合静脉重建患者的预后情况。方法:回顾性收集2012年1月至2016年6月4个大型医学中心的266例接受联合静脉切除重建的胰腺癌手术患者的临床资料。将266例患者按3:1比例随机分为建模组(201例)和验证组(65例),人口统计学因素和影像学因素纳入到单因素和多因素Cox回归分析。应用C-index和校正曲线来评判最终的列线图模型,并借助65例验证组患者数据资料进行验证。我们将血管异常在CT的表现分为4种分型,并纳入到新的预测模型。通过卡方检验分析血管异常在影像学和病理学表现上的相关性。结果:年龄、肿瘤与血管接触长度和血管异常程度是患者预后生存的独立危险因素(P值分别为0.002,0.016,0.001)。新建立的列线图模型有着较好的预后预测能力,该模型预测建模组和验证组的总生存期的C-index分别为0.811和0.800。将CT上血管异常程度的7个特征表现(无异常、轻度变形、泪滴征、集束征、狭窄1/2、闭塞和栓子)根据不同的预后分为1型(无异常)、2型(轻度变形或泪滴征)、3型(集束征或狭窄1/2)和4型(闭塞或栓子)。血管异常的影像学表现和病理学结果的相关性程度较高。结论:新建立的列线图模型能够准确地预测联合胰腺癌手术联合静脉切除重建患者术后的总生存期。
[Abstract]:Background: most patients with pancreatic cancer are in advanced stage of diagnosis, often accompanied by peripancreatic vascular invasion. However, the traditional evaluation criteria of computed tomography (CT) focus on whether the blood vessels are invaded or not, but less on the long-term survival and prognosis of the patients. Therefore, we hope to establish a new and effective image-based evaluation model to predict the prognosis of patients with pancreatic cancer combined with venous reconstruction. Methods: the clinical data of 266 patients with pancreatic cancer underwent combined venectomy and reconstruction from January 2012 to June 2016 were retrospectively collected. Two hundred and six patients were randomly divided into modeling group (201 cases) and validation group (65 cases) according to 3:1 ratio. Demographic and imaging factors were included in univariate and multivariate Cox regression analysis. C-index and calibration curves were used to evaluate the final line graph model, and 65 patient data of the validation group were used to verify the model. We divided the CT findings of vascular abnormalities into four types and incorporated them into a new predictive model. The correlation between imaging and pathological findings of vascular abnormalities was analyzed by chi-square test. Results: age, tumor and vascular contact length and degree of vascular abnormality were independent risk factors for survival of patients with prognosis (P = 0.002, 0.016, 0.001, respectively). The new line graph model has good prognostic prediction ability. The C-index of the total survival time of the modeling group and the validation group is 0.811 and 0.800, respectively. Seven features (no abnormality, slight deformation, tear drop sign, cluster sign) of the abnormal blood vessels on CT were presented. According to different prognosis, stenosis 1 / 2, occlusion and embolus were divided into 1 type (no abnormal type 2) (mild deformation or tear sign) and 4 type (occlusion or embolus) (cluster sign or stenosis 1 / 2). There is a high correlation between the imaging findings of vascular abnormalities and pathological results. Conclusion: the new line graph model can accurately predict the total survival time of patients with pancreatic cancer combined with venous resection and reconstruction.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9
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本文编号：1779110