摘要
目的探讨基于经直肠超声造影参数的Logistic回归模型评估局部进展期直肠癌(LARC)新辅助放化疗(NCRT)疗效的临床价值。方法选取于我院接受NCRT后并行全直肠系膜切除术的LARC患者96例,根据病理肿瘤退缩分级(pTRG)将其分为反应良好组(pTRG 0、1级)34例和反应不佳组(pTRG 2、3级)62例。比较两组治疗前、后肿瘤长径、厚径、肿瘤内主要动脉的收缩期峰值血流速度(PSV)和阻力指数(RI)、超声造影不均匀增强程度分级(CEUS-IG_(治疗前)和CEUS-IG_(治疗后)),以及治疗后长径变化率、厚径变化率、PSV变化率、RI变化率、CEUS-IG降级占比的差异;应用Logistic回归分析预测LARC患者NCRT反应良好的独立影响因素,并建立Logistic回归模型;绘制受试者工作特征(ROC)曲线分析该模型及单一参数预测LARC患者NCRT反应良好的诊断效能。结果两组CEUS-IG_(治疗后)、肿瘤长径变化率、PSV变化率、CEUS-IG降级占比比较差异均有统计学意义(均P<0.05);其余参数比较差异均无统计学意义。Logistic回归分析显示,PSV变化率、CEUS-IG_(治疗后)、CEUS-IG降级均为预测LARC患者NCRT反应良好的独立影响因素(OR=6.95、15.69、4.62,均P<0.05)。ROC曲线分析显示,Logistic回归模型预测LARC患者NCRT反应良好的特异度、准确率和AUC均最高,分别为94.10%、84.4%、0.917,且其AUC与单一参数比较差异均有统计学意义(均P<0.05)。结论基于经直肠超声造影参数的Logistic回归模型在评估LARC患者NCRT疗效中有一定临床价值。
Objective To investigate the clinical value of Logistic regression model based on transrectal contrastenhanced ultrasound parameters in assessing the efficacy of neoadjuvant chemoradiotherapy(NCRT)for locally advanced rectal cancer(LARC).Methods Totally 96 patients with LARC who underwent NCRT and subsequent total mesorectal excision in our hospital were selected and divided into good response group(pTRG 0,1,n=34)and poor response group(pTRG 2,3,n=62)according to the pathological tumor regression grade(pTRG).The differences of tumor long diameter,thickness,peak systolic velocity(PSV)and resistance index(RI)of the main artery inside the tumor,the contrast-enhanced ultrasound inhomogeneity grade(CEUS-IG_(pre) and CEUS-IG_(post))before and after treatment,and long diameter change rate,thickness change rate,PSV change rate,RI change rate,the proportion of CEUS-IG downgrade of the tumor after treatment were compared.Logistic regression analysis was applied to predict independent influences on the efficacy of NCRT in patients with LARC,and a Logistic regression model was established.Receiver operating characteristic(ROC)curve was drawn to analyze the Logistic regression model and a single parameter in predicting the diagnostic efficacy of good NCRT response in LARC patients.Results There were statistically significant differences in CEUS-IG_(post),tumor long diameter change rate,PSV change rate and the proportion of CEUS-IG downgrade between the two groups(all P<0.05),while the differences in the rest parameters were not statistically significant.Logistic regression analysis showed that PSV change rate,CEUS-IGpost and CEUS-IG downgrade were independent influencing factors in predicting the efficacy of NCRT in LARC patients(OR=6.95,15.69,4.62,all P<0.05).ROC curve analysis showed that the Logistic regression model had the highest specificity,accuracy and AUC for predicting good NCRT response in LARC patients,with 94.10%,84.4%and 0.917,respectively.The AUC of the model was statistically significant differences compared with that of a single parameter(all P<0.05).Conclusion The Logistic regression model based on transrectal contrastenhanced ultrasound parameters has certain clinical value in assessing the efficacy of NCRT in LARC patients.
作者
廖中凡
罗源
敬基刚
杨音
闫静文
彭玉兰
庄华
LIAO Zhongfan;LUO Yuan;JING Jigang;YANG Yin;YAN Jingwen;PENG Yulan;ZHUANG Hua(Department of Ultrasound,West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《临床超声医学杂志》
CSCD
2023年第5期384-389,共6页
Journal of Clinical Ultrasound in Medicine
关键词
超声检查
经直肠
造影剂
直肠癌
局部进展期
肿瘤退缩分级
新辅助放化疗
Ultrasonography,transrectal
Contrast agent
Rectal cancer,locally advanced
Tumor regression grade
Neoadjuvant chemoradiotherapy
