摘要
目的:探讨增强CT下细胞外体积分数对直肠癌术前病理分级及新辅助放化疗疗效的预测价值。方法:回顾分析2019年5月-2023年12月,本院病理证实的108例完成新辅助放化疗及根治性手术的直肠癌患者。根据病理学两级分级法,将患者分为低级别组与高级别组。基于新辅助放化疗退缩分级法进一步筛选57例患者,分为反应良好组与反应不良组。通过增强CT计算患者ECV,采用最小绝对收缩和选择算子(LASSO)筛选变量进一步运用二元逻辑回归(logistic回归)分析。通过受试者工作特征曲线(ROC)评估ECV及联合指标的预测效能,利用Delong检验比较不同组别的曲线下面积(AUC)差异。结果:病理分级研究中高级别组新辅助放化疗前ECV(ECVpre)显著高于低级别组,且差异有统计学意义(P<0.001);AUC为0.74(95%CI=0.62~0.86)。新辅助放化疗疗效研究中反应良好组新辅助放化疗后的ECV(ECVpost)、新辅助放化疗前后ECV差值(△ECV)及两者联合指标显著低于反应不良组,差异有统计学意义(P<0.05),其AUC值分别为0.87、0.86和0.91(95%CI分别是0.78~0.97、0.74~0.98、0.83~0.99)。结论:基于增强CT的ECVpre对直肠癌术前病理分级具有预测价值,基于增强CT的ECVpost、△ECV对术前直肠癌新辅助放化疗疗效预测具有较高的准确性。
Objective:To investigate the predictive value of extracellular volume fraction(ECV)derived from enhanced CT in preoperative pathological grading and in evaluating the efficacy of neoadjuvant chemoradiotherapy(nCRT)in rectal cancer.Methods:This retrospective study included 108 patients with pathologically confirmed rectal cancer who underwent nCRT and radical surgery at Shunde Hospital,Southern Medical University(May 2019-December 2023).Patients were stratified into low-and high-grade groups using a two-tier pathological grading system.In addition,57 patients with complete pre-and post-nCRT CT data were divided into good-and poor-response groups according to tumor regression grading.ECV was calculated from enhanced CT,and variables were selected using LASSO regression followed by binary logistic regression.Predictive performance was assessed with ROC curves,and AUCs were compared using the DeLong test.Results:In the pathological grading analysis,pretreatment ECV(ECVpre)was significantly higher in the high-grade group than in the low-grade group(P<0.001),with an AUC of 0.74(95%CI:0.62~0.86).In the nCRT efficacy analysis,post-treatment ECV(ECVpost),the change in ECV(△ECV),and their combined indices were significantly lower in the good-response group(all P<0.05),with AUCs of 0.87,0.86,and 0.91,respectively.Conclusion:ECVpre from enhanced CT has predictive value for preoperative pathological grading of rectal cancer.ECVpost and△ECV demonstrate high accuracy in predicting response to nCRT,supporting their potential role in clinical decision-making.
作者
李允静
欧阳富盛
黄锡谊
周兰妮
胡秋根
郭保亮
LI Yun-jing;OUYANG Fu-sheng;HUANG Xi-yi(Department of Radiology,Shunde Hospital,Southern Medical University(The First People’s Hospital of Shunde,Foshan),528308,China)
出处
《放射学实践》
北大核心
2025年第10期1276-1284,共9页
Radiologic Practice
基金
广东省医学科学技术研究基金项目(A2023204、A2024338、A2024582)
广东省普通高校特色创新类项目(2023KTSCX022)
佛山市顺德区医学骨干人才培养项目资助
南方医科大学顺德医院临床研究启动计划项目(CRSP2022005)
佛山市自筹经费类科技创新项目(2220001004816、2220001004195)
南方医科大学顺德医院科研启动计划项目(SRSP2021021)
佛山市顺德区乐从医院院内科研项目(A202303)
佛山市医学影像人工智能应用工程技术研究中心项目(361077)。
关键词
直肠肿瘤
X线影像增强
放化疗
辅助
治疗结果
Rectal neoplasms
Radiographic image enhancement
Chemoradiotherapy,adjuvant
Treatment outcome
