摘要
目的分析多层螺旋CT(MSCT)定量技术预测合并慢性阻塞性肺疾病(COPD)肺癌患者放疗效果的价值。方法采用回顾性研究方法,对象选取2017年1月至2018年6月收治的74例肺癌合并COPD患者,均接受调强适形放射治疗,予MSCT检查,测定支气管管腔直径、支气管壁厚度(WT)、管腔面积(AL)、管壁厚度与外直径比值(TDR)、管壁面积占断面总面积比值(WA%)、肺气肿指数(EI)、肺/主动脉直径(PA/A)比值,按放疗效果分为有效组与无效组,比较两组影像学定量参数的差异,并分析MSCT定量指标预测合并COPD肺癌患者近期疗效的价值。结果74例肺癌合并COPD患者完全缓解1例(1.35%),部分缓解29例(39.19%),稳定34例(45.95%),进展10例(13.51%),总有效率为40.54%。有效组FEV1、FEV1/FVC、FEV1%均高于无效组(t=10.475、4.454、3.925,P均<0.01);有效组WT、TDR、WA%、PA/A、EI均低于无效组,AL高于无效组(t=3.715、3.893、4.655、3.339、5.280、4.915,P均<0.01)。MSCT各参数预测合并COPD肺癌近期放疗疗效综合效能前三位参数分别为WT、TDR与EI。WT约登指数最大时(0.821),对应截断值≤1.36,预测近期疗效敏感度、特异度分别为86.67%、95.45%,曲线下面积(AUC)为0.911;TDR约登指数最大时(0.809),对应截断值≤0.24,预测近期疗效敏感度、特异度分别为90.00%、90.91%,AUC为0.907;EI约登指数最大时(0.696),对应截断值≤20.01,预测近期疗效敏感度、特异度分别为90.00%、79.55%,AUC为0.878。WT、TDR、WA%、PA/A、EI与合并COPD肺癌患者肺功能指标FEV1、FEV1/FVC、FEV1%分别呈负相关关系(P<0.05,P<0.01),AL与合并COPD肺癌患者肺功能指标FEV1、FEV1/FVC、FEV1%分别呈正相关关系(P均<0.01)。结论MSCT技术可定量测定合并COPD肺癌患者肺功能及气道损伤情况,对预测放疗近期效果有较高的价值。
Objective To investigate the value of multi-slice spiral computed tomography(MSCT)quantitative technology in predicting the radiotherapy effect of lung cancer patients combined with chronic obstructive pulmonary disease(COPD).Methods A total of 74 lung cancer patients combined with COPD admitted from January 2017 to June 2018 who treated with intensity modulated radiotherapy(IMRT)was retrospective studied.MSCT was used to measure the diameter of bronchus lumen,the thickness of bronchus wall(WT),the area of bronchus lumen(AL),the ratio of wall thickness to external diameter(TDR),the ratio of wall area to total cross-sectional area(WA%),the emphysema index(EI),the ratio of pulmonary/aortic diameter(PA/A).According to the effect of radiotherapy,the patients were divided into two groups:the effective group and the ineffective group.The differences of imaging quantitative parameters between the two groups were compared,and the value of MSCT quantitative index in predicting the short-term effect of lung cancer patients with COPD was analyzed.Results Among 74 cases of lung cancer with COPD,1 case was complete remission(1.35%),29 cases were partial remission(39.19%),34 cases were stable(45.95%),10 cases were progressive(13.51%),and the total effective rate was 40.54%.FEV1,FEV1/FVC,FEV1%in the effective group were higher than that in the ineffective group(t=10.475,4.454,3.925,all P<0.01).WT,TDR,WA%,PA/A and EI in the effective group were lower than those in the ineffective group,and AL was higher than those in the ineffective group(t=3.715,3.893,4.655,3.339,5.280,4.915,all P<0.01).WT,TDR and EI were the top three parameters of MSCT in predicting the comprehensive efficacy of COPD lung cancer.When the WT Youden index was the highest(0.821),the corresponding cutoff value was≤1.36,the sensitivity and specificity of the predicted short-term efficacy were 86.67%and 95.45%respectively,and the area under the curve(AUC)was 0.911.When the TDR Youden index was the largest(0.809),the corresponding cutoff value was≤0.24,the sensitivity and specificity of the predicted short-term efficacy were 90.00%,90.91%,and AUC was 0.907.When the EI Youden index was the largest(0.696),the corresponding cutoff value was≤20.01,and the sensitivity and specificity of the predicted short-term efficacy were 90.00%,79.55%,and AUC was 0.878.WT,TDR,WA%,PA/A,EI were negatively correlated with FEV1,FEV1/FVC and FEV1%(P<0.05,P<0.01).AL was positively correlated with FEV1,FEV1/FVC and FEV1%(all P<0.01).Conclusion MSCT can be used to quantitatively measure the lung function and airway damage of lung cancer patients with COPD,which has a high value in predicting the short-term effect of radiotherapy.
作者
任会丽
方伟军
洪贤
REN Hui-li;FANG Wei-jun;HONG Xian(Department of Radiology,Guangzhou Chest Hospital,Guangzhou,Guangdong 510095,China)
出处
《中国临床研究》
CAS
2020年第7期884-889,共6页
Chinese Journal of Clinical Research
基金
广东省科技计划项目(2017ZC0363)。
关键词
慢性阻塞性肺疾病
肺癌
放射治疗
多层螺旋X线电子计算机断层扫描
定量
肺功能
气道损伤
Chronic obstructive pulmonary disease
Lung cancer
Radiotherapy
Multi-slice spiral computed tomography
Quantification
Lung function
Airway injury
