摘要
目的探讨序贯CT纵向评估局部进展期胃癌(LAGC)新辅助免疫化疗(nICT)疗效的价值。方法回顾性分析2021年1月至2023年12月115例接受nICT联合手术治疗的LAGC患者的临床及CT影像资料。所有患者于治疗前1周内和nICT结束后2周内行动脉期(AP)、静脉期(VP)和延迟期(DP)三期增强CT扫描。测量增强各期胃癌病灶的CT值,计算CT值变化绝对值(ΔCT=治疗后CT值-治疗前CT值)及其变化率[ΔCT%=(治疗后CT值-治疗前CT值)/治疗前CT值×100%]。根据术后美国癌症联合会(AJCC)肿瘤退缩分级(TRG)标准将患者分为病理缓解良好组(TRG 0、1)和缓解不良组(TRG 2、3)。比较两组间临床指标和CT值的差异,计量资料采用Student’s t检验或MannWhitney U检验,分类资料采用卡方检验或Fisher’s确切概率法,采用多因素逻辑回归方法筛选病理缓解不良的独立风险因素,采用受试者工作特征曲线(ROC)和曲线下面积(AUC)评估影像学指标的效能。结果男性90例,女性25例,年龄31~81岁,中位年龄61岁。病理缓解良好44例,缓解不良71例。缓解良好组治疗前静脉期和延迟期CT值(VP/DP-前)及治疗后各期CT值(AP/VP/DP-后)显著低于缓解不良组(P<0.05),逻辑回归分析显示治疗前延迟期CT值(DP-前)和治疗后动脉期CT值(AP-后)及肿瘤厚度是病理缓解不良的独立危险因素,联合三者构建联合参数评价疗效的AUC为0.770(95%CI:0.683~0.844),依次高于治疗后肿瘤厚度、DP-前及AP-后,AUC分别为0.660、0.667、0.665(P<0.05)。结论nICT治疗前后序贯多期增强CT是纵向评价疗效的有效方法,DP-前和AP-后和治疗后肿瘤厚度是疗效的独立预测因素,联合三者能进一步提高效能。
Objective To investigate the value of sequential CT for longitudinal assessment of treatment response to neoadjuvant immuno‐chemotherapy(nICT)in locally advanced gastric cancer(LAGC).Methods Between January 2021 and December 2023,clinical and CT imaging data of 115 patients with locally advanced gastric adenocarcinoma who underwent nICT followed by surgery were retrospectively analyzed.Triple‐phase enhanced CT scans(arterial,venous,and delayed phases)were performed within 1 week before the initiation of nICT and 2 weeks after its completion.The CT attenuation values of gastric cancer lesions were measured in each phase,and the absolute changes(ΔCT=CTpost-CTpre)and percentage changes[ΔCT%=(CTpost-CTpre)/CTpre×100%]were calculated.Patients were categorized into good responders(TRG=0+1)and poor responders(TRG=2+3)based on the postoperative AJCC tumor regression grade(TRG).Differences in clinical indicators and CT attenuation values between the two groups were compared using Student's t‐test or Mann⁃Whitney U test for continuous variables and Chi⁃square test or Fisher's exact test for categorical data.Multivariable Logistic regression analysis was used to identify independent risk factors for poor response.The diagnostic performance of imaging indicators was evaluated using the area under the receiver operating characteristic curve(AUC).Results The study included 90 males and 25 females,with ages ranging from 31 to 81 years(median 61 years).There were 44 good responders and 71 poor responders.The pre‐treatment venous phase(VP‐pre)and delayed phase(DP‐pre)CT attenuation values and posttreatment CT attenuation values in all phases(AP‐post,VP‐post,DP‐post)were significantly lower in good responders than in poor responders(P<0.05).Multivariable logistic regression analysis revealed that pre‐treatment delayed phase CT attenuation(DP‐pre),post‐treatment arterial phase CT attenuation(AP‐post),and tumor thickness were independent risk factors for poor response.The combined model of these three parameters had the highest AUC of 0.770(95%CI:0.683-0.844),which was significantly higher than the AUCs of tumor thickness(0.660),DP‐pre(0.665),and AP‐post(0.667)alone(P<0.05).Conclusion Multi‐phase enhanced sequential CT before and after nICT is an effective method for longitudinal assessment of treatment response.Pre‐treatment delayed phase CT attenuation,post‐treatment arterial phase CT attenuation,and tumor thickness are independent predictors of treatment response,and their combination further improves diagnostic performance.
作者
王健
贝天霞
王艺
蒋志强
徐淑宁
陈望
李靖
WANG Jian;BEI Tianxia;WANG Yi(Department of Radiology,The First Affiliated Hospital,College of Clinical Medicine of Henan University of Science and Technology,Luoyang,Henan Province 471000,P.R.China)
出处
《临床放射学杂志》
北大核心
2025年第7期1276-1282,共7页
Journal of Clinical Radiology
基金
国家自然科学基金青年项目(编号:82202146)
河南省医学科技攻关计划省部共建重点项目(编号:SBGJ202402030)
河南省科技厅重点科技攻关项目(编号:242102311173)。
关键词
多期增强CT
胃肿瘤
治疗反应
新辅助治疗
Multi‐phase enhanced CT
Stomach neoplasms
Treatment response
Neoadjuvant therapy
