摘要
目的 应用经直肠双平面超声(TRUS)评估局部进展期直肠癌(LARC)患者新辅助放化疗(nCRT)疗效及再分期情况,探讨其临床应用价值.方法 选取于我院行nCRT的LARC患者106例,按病理结果分为病理完全缓解者42例[pCR组,肿瘤退缩分级(TRG)0级]和非病理完全缓解者64例(非pCR组,TRG 1～3级),均于nCRT前后行TRUS检查,获取肿瘤长径、厚度、血流阻力指数(RI)、超微血流成像(MFI)分级、应变弹性成像(SE)评分及各参数的变化率;比较pCR组与非pCR组TRUS参数的差异,以及超声T分期与病理T分期、超声TRG与病理TRG的一致性.绘制受试者工作特征(ROC)曲线分析各参数变化率对LARC患者nCRT后pCR的诊断效能.结果 nCRT后pCR组和非pCR组肿瘤长径、厚度、RI、MFI分级、SE评分均较nCRT前减小,差异均有统计学意义(均P<0.05);nCRT后pCR组长径、厚度、RI、MFI分级、SE评分均小于非pCR组,长径、厚度、RI、MFI分级、SE评分变化率均大于非pCR组,差异均有统计学意义(均P<0.05).nRCT后超声T分期的准确率为65.1％,其中T3期的准确率最高(78.8％),与病理T分期的一致性一般(Kappa=0.517,P<0.05);超声TRG的准确率为89.6％,与病理TRG的一致性较高(Kappa=0.789,P<0.05).ROC曲线分析显示,肿瘤长径、厚度、RI、MFI分级、SE评分变化率评估LARC患者nCRT后pCR的截断值分别为67.75％、71.75％、36.88％、51.70％、39.20％,其对应的曲线下面积分别为0.884、0.836、0.857、0.790、0.701,灵敏度分别为84.4％、92.2％、93.8％、96.9％、84.4％,特异度分别为83.3％、76.2％、66.7％、54.8％、54.8％.结论 TRUS对LARC患者nCRT后pCR有较好的评估价值,超声T分期及TRG的准确率均较高,具有一定的临床价值.
Abstract
Objective To explore the clinical value of transrectal biplane ultrasound(TRUS)in evaluating the efficacy of neoadjuvant chemoradiotherapy(nCRT)and restaging for locally advanced rectal cancer(LARC).Methods A total of 106 LARC patients who underwent nCRT in our hospital were selected.According to the pathological results,they were divided into the complete pathologic response group[pCR group,tumor regression grade(TRG)0 grade]with 42 cases and non-response group(non-pCR group,TRG 1～3 grade)with 64 cases.All patients underwent TRUS before and after nCRT,tumor long diameter,thickness,flow resistance index(RI),micro-flow imaging(MFI)grading,strain elastography(SE)score and their change rates were obtained.The differences in TRUS parameters between pCR group and non-pCR group were compared,as well as the consistency between ultrasound T staging and pathological T staging,ultrasound TRG and pathological TRG.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of TRUS parameters change rate for pCR after nCRT in LARC patients.Results After nCRT,the long diameter,thickness,RI,MFI grading and SE score of the tumor in pCR group and non-pCR group were all reduced compared with those before nCRT,and the differences were statistically significant(all P<0.05).After nCRT,the long diameter,thickness,RI,MFI grading and SE score in the pCR group were lower than those in the non-pCR group,and the change rates of the long diameter,thickness,RI,MFI grading and SE score were all higher than those in the non-pCR group,with statistically significant differences(all P<0.05).The accuracy of ultrasound T staging after nCRT was 65.1％,among which the accuracy of T3 staging was the highest(78.8％),the consistency with pathological T staging was moderate(Kappa=0.517,P<0.05).The accuracy of ultrasound TRG was 89.6％,the consistency with pathological TRG was high(Kappa=0.789,P<0.05).ROC curve analysis demonstrated that the cut-off values of the change rates of the long diameter,thickness,RI,MFI grading and SE score for assessing pCR in LARC patients after nCRT were 67.75％,71.75％,36.88％,51.70％,39.20％with corresponding area under the curve of 0.884,0.836,0.857,0.790,0.701,sensitivity of 84.4％,92.2％,93.8％,96.9％,84.4％,and specificity of 83.3％,76.2％,66.7％,54.8％,54.8％,respectively.Conclusion TRUS T staging and TRG after nCRT in LARC patients are remarkably consistent with the pathological results,and holds a significant and favorable value in the assessment of pCR.
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