能谱CT碘基值预测局部进展期胃腺癌新辅助化疗疗效
Spectral CT based iodine concentration for the prediction of treatment response to neoadjuvant chemother-apy in locally advanced gastric cancer
马千昂 1黎海亮 1王艺 2蒋志强 3徐淑宁 4李靖1
作者信息
- 1. 450008 郑州,郑州大学附属肿瘤医院(河南省肿瘤医院)医学影像科
- 2. 450008 郑州,郑州大学附属肿瘤医院(河南省肿瘤医院)病理科
- 3. 450008 郑州,郑州大学附属肿瘤医院(河南省肿瘤医院)普外科
- 4. 450008 郑州,郑州大学附属肿瘤医院(河南省肿瘤医院)消化肿瘤内科
- 折叠
摘要
目的:探讨基线期能谱CT碘基值预测局部进展期胃腺癌新辅助化疗(NAC)后病理学反应的应用价值.方法:2021 年 1 月至 2021 年 12 月间,前瞻性对拟行新辅助化疗联合手术治疗的局部进展期胃腺癌患者于治疗前 1 周内行能谱CT 动脉期、静脉期和延迟期三期增强扫描.收集患者临床病理信息,测量增强各期胃癌病灶的碘基值(IC),并除以主动脉碘基值得到标化碘基值(nIC).根据术后AJCC肿瘤退缩分级(TRG)标准分为病理缓解良好组(TRG＝0+1)和病理缓解不良组(TRG＝2+3).比较两组间临床指标和碘基值的差异,采用多因素回归方法筛选胃癌 NAC 疗效的独立预测因素,采用受试者工作特征曲线和曲线下面积(AUC)评估 IC 值的预测效能.结果:筛选出符合条件的患者70 例,其中男 55 例,女 15 例,年龄范围 30～71 岁,中位年龄 59 岁.病理缓解良好 22 例,缓解不良 48例.缓解良好组的静脉期标化碘基值(nICVP)、延迟期标化碘基值(nICDP)值低于缓解不良组,差异有统计学意义(t＝2.391、2.270,P 均＜0.05);回归分析结果显示 nICVP 和 CT 报告淋巴结状态是胃癌NAC疗效的独立预测指标,联合两者的诺模图预测胃癌NAC后病理学反应的AUC为 0.821(95%CI:0.711～0.902),依次高于nICVP、联合nICVP和nICDP、nICDP(Z＝2.306、2.161、2.228,P 均＜0.05),以诺模图分数＞0.684 为诊断阈值,其预测病理缓解不良的敏感度、特异度、阳性预测值、阴性预测值分别为 75.00%、81.80%、65.58%、87.71%.结论:基线期胃癌病灶 nICVP 和 nICDP 能鉴别新辅助化疗后不同病理缓解状态,nICVP和CT报告淋巴结状态是预测新辅助化疗疗效的独立风险因素,联合两者能进一步提高预测效能.
Abstract
Objective:This study aims to investigate the value of baseline spectral CT-based io-dine concentration for predicting pathologic response in patients with locally advanced gastric adeno-carcinomas after neoadjuvant chemotherapy(NAC).Methods:Between January 2021 and December 2021,triple-phase enhanced CT scans(arterial phase,venous phase,delay phase),using gemstone spectral imaging(GSI)mode,were prospectively performed within one week before treatment in lo-cally advanced gastric adenocarcinoma patients scheduled for NAC plus gastrectomy.Clinicopathologi-cal data were collected,and iodine concentration(IC)of gastric cancer at three enhanced phases was measured and normalized against that in the aorta to generate normalized IC(nIC).Patients were di-vided into responders(TRG＝0+1)and non-responders(TRG＝2+3),based on the tumor regression grading(TRG)system by AJCC criteria on surgical specimen,and differences in clinical indicators and IC values were compared.Multivariable logistic regression analysis was used to screen independent pre-dictors for response to NAC.The predictive efficacy of IC values was assessed by the area under the curve(AUC)of receiver operating characteristic(ROC)analysis.Results:A total of 70 patients,inclu-ding 55 males and 15 females,were enrolled,with an age range of 30～71 years(mean of 59 years).Of these,22 patients were responders and 48 were non-responders.The values of nICVP and nICDP in re-sponders were statistically lower than those in non-responders(t＝2.391,2.270,7.358,P＜0.05).Lo-gistic regression analysis revealed nICVP and CT reported LN status as independent predictors for pathologic response to NAC.The nomogram including nICVP and CT reported LN status exhibited an AUC of 0.821(95%CI,0.711～0.902),which was statistically higher than that of nICVP,combination of nICVP and nICVP,nICDP with 0.668,0.666,0.657(Z＝2.306,2.161,2.228,all P＜0.05),with the nomogram score＞0.684 as the cutoff value.Its sensitivity,specificity,positive predictive value,and negative predictive value for predicting non-responders were 75.00%,81.80%,65.58%,and 87.71%,respectively.Conclusion:Baseline nICVP and nICDP in the primary gastric cancer lesion can distinguish different pathologic responses after NAC,and nICVP and CT reported LN status are independent risk factors for treatment response to NAC.The nomogram based on these two factors further improves ef-ficacy.
关键词
能谱CT/体层摄影术,X线计算机/碘基值/胃肿瘤/疗效预测/新辅助化疗Key words
Spectral CT/Tomography,X-ray computed/Iodine concentration/Gastric neo-plasms/Treatment response prediction/Neoadjuvant chemotherapy引用本文复制引用
基金项目
河南省科技厅科技攻关计划重点项目(202102310736)
河南省中青年卫生健康科技创新优秀青年人才培养项目(YXKC2021054)
国家自然科学基金青年基金(82202146)
出版年
2024
NETL
NSTL
维普
万方数据