摘要
目的 探讨MRI与术前血清学指标鳞状细胞癌抗原(SCC-Ag)、中性粒细胞与淋巴细胞比值(NLR)及活检病理联合对早期宫颈癌淋巴结转移(LNM)的预测价值。方法 选取2019年1月-2022年2月在蚌埠医学院第一附属医院行初次手术的宫颈癌患者307例,按术后病理是否存在淋巴结转移分为淋巴结转移组81例和未转移组226例,比较2组患者的MRI淋巴结短径、肿瘤直径、间质浸润深度、宫旁浸润和阴道受累,术前血清学指标以及病理特征。分析联合诊断对淋巴结转移的预测价值。结果 Logistic回归分析显示MRI淋巴结短径大、MRI肿瘤直径大、MRI间质浸润深度>1/2肌层、MRI宫旁浸润、术前SCC-Ag水平升高和脉管浸润是宫颈癌淋巴结转移的独立危险因素(均P<0.05)。MRI淋巴结短径、术前SCC-Ag水平、NLR诊断宫颈癌LNM的ROC曲线下面积分别为0.806、0.711、0.630,最佳截断值分别为8.50 mm、2.55 ng/mL、1.90,灵敏度分别为0.654、0.593、0.593,特异度分别为0.881、0.757、0.642;MRI淋巴结短径联合SCC-Ag诊断的ROC曲线下面积为0.846;MRI淋巴结短径、术前SCC-Ag水平、NLR三者联合诊断的ROC曲线下面积为0.863。多指标(术前SCC-Ag水平、MRI淋巴结短径、肿瘤直径、间质浸润深度、宫旁浸润以及脉管浸润)联合诊断宫颈癌LNM的ROC曲线下面积为0.926。结论 影像学检查与血清学指标和临床病理特征联合可以提高对宫颈癌淋巴结转移的预测价值。
Objective This study aims to investigate the predictive value of MRI combined with preoperative serological markers: squamous cell carcinoma antigen(SCC-Ag), neutrophil to lymphocyte ratio(NLR) and biopsy pathology in lymph node metastasis of early cervical cancer. Methods A total of 307 patients who underwent primary surgery in the First Affiliated Hospital of Bengbu Medical College from January 2019 to February 2022 were selected and divided into lymph node metastasis group(81 cases) and no lymph node metastasis group(226 cases) according to the presence or absence of lymph node metastasis after surgery. The MRI lymph node short diameter, tumour size, interstitial infiltration depth, parauterine and vaginal involvement, preoperative serological indices and pathological features of the 2 groups were compared. The predictive value of lymph node metastasis and the significance of combined diagnosis were analysed. Results Logistic regression analysis showed that large short diameter of MRI lymph nodes, large tumor diameter, depth of interstitial infiltration greater than 1/2 muscular layer, parametrial involvement, increased expression of SCC-Ag and positive vascular were independent risk factors for lymph node metastasis of cervical cancer( P<0.05). The areas under the ROC curve of MRI lymph node diameter, SCC-Ag and NLR for the diagnosis of cervical cancer LNM were 0.806, 0.711 and 0.630, respectively. The optimal cut-off values were 8.50 mm, 2.55 ng/mL and 1.90, respectively. The sensitivity values were 0.654, 0.593 and 0.593, respectively, and the specificity values were 0.881, 0.757 and 0.642, respectively. The area under the ROC curve of MRI lymph node short diameter combined with SCC-Ag diagnosis was 0.846. The area under ROC curve for the combined diagnosis of MRI lymph node short diameter, SCC-Ag and NLR was 0.863. The area under ROC curve of multiple indicators(SCC-Ag, MRI lymph node short diameter, tumour size, interstitial infiltration depth, parauterine involvement, and vascular positive) for combined diagnosis of cervical cancer LNM was 0.926. Conclusion Imaging examination(MRI) combined with serological indicators and clinicopathological features can improve the predictive value of cervical cancer lymph node metastasis.
作者
赵梦秋
晋茂生
刘红丽
刘健
ZHAO Meng-qiu;JIN Mao-sheng;LIU Hong-li;LIU Jian(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China;不详)
出处
《中华全科医学》
2023年第2期199-202,303,共5页
Chinese Journal of General Practice
基金
安徽省高校自然科学重点项目(KJ2019A0346)。
关键词
宫颈癌
淋巴结转移
磁共振成像
鳞状细胞癌抗原
中性粒细胞与淋巴细胞比值
Cervical cancer
Lymph node metastasis
Magnetic resonance imaging
Squamous cell carcinoma antigen
Neutrophil-lymphocyte ratio
