摘要
目的:探讨高分辨磁共振成像(HR-MRI)评估老年直肠癌(Rectal cancer,RC)壁外血管侵犯(EMVI)与肿瘤淋巴结转移的关系.方法:选取2020年1月—2023年12月我院收治的184例老年RC患者作为研究对象,采用HR-MRI技术评估患者是否出现EMVI阳性,分析T分期与HR-MRI检测到的EMVI阳性率之间的相关性.为进一步研究,将老年RC患者分为淋巴结转移组和非淋巴结转移组,通过单因素和多因素Logistic回归分析确定淋巴结转移的影响因素.采用ROC曲线分析影像学技术对淋巴结转移的预测价值.结果:T4分期中HR-MRI-EMVI的阳性比例显著高于T3、T2及T1分期(P<0.05),且T3分期中HR-MRI-EMVI的阳性比例亦高于T2和T1分期(P>0.05).在184例RC患者中,依据术后病理组织学的检查结果,将患者分为淋巴结转移组(n=66)和非淋巴结转移组(n=118)两组.统计分析结果显示,T分期、肿瘤直径、分化程度、HR-MRI-EMVI阳性、脉管浸润和神经侵犯等指标在两组间存在显著差异,具有统计学意义(P<0.05).Logistic回归分析显示以下因素为老年RC患者淋巴结转移的显著危险因素(P<0.05):HR-MRI-EMVI阳性(OR=1.680,95％CI:1.243～2.272)、脉管浸润(OR=1.919,95％CI:1.264～2.914)、神经侵犯(OR=1.680,95％CI:1.162～2.429)、T分期(OR=1.559,95％CI:1.235～1.968)、肿瘤直径(OR=1.791,95％CI:1.159～2.768)和分化程度(OR=1.808,95％CI:1.030～3.173).ROC曲线分析结果显示,HR-MRI-EMVI阳性的曲线下面积(AUC)为0.632(95％CI:0.547～0.717)、脉管浸润的AUC为0.809(95％CI:0.743～0.875)、神经侵犯的AUC为0.662(95％CI:0.576～0.747)、分化程度的AUC为0.607(95％CI:0.519～0.694)、肿瘤直径的AUC为0.581(95％CI:0.495～0.668)、T分期的AUC为0.632(95％CI:0.552～0.713),回归分析的AUC为0.964(95％CI:0.940～0.988),显著高于任一单一诊断指标的AUC,表明该回归模型具有较好的预测价值.结论:HR-MRI技术在评估老年RC患者EMVI方面具有较高价值,且T分期与HR-MRI-EMVI阳性率显著相关,多项临床病理因素被确定为老年RC患者淋巴结转移的危险因素,综合考虑这些因素可提高淋巴结转移的预测准确性,提示HR-MRI技术结合临床病理因素可作为评估老年RC患者淋巴结转移风险的有效手段.
Abstract
Objective:To explore the high-resolution magnetic resonance imaging (HR-MRI) for assessing the correlation between extramural vascular invasion(EMVI) and tumor lymph node metastasis in elderly rectal cancer(RC) patients. Methods:A total of 184 elderly RC patients admitted to our hospital from October 2020 to August 2023 were selected as the research subjects. HR-MRI technology was used to evaluate whether the patients were EMVI positive,and the correlation between T stage and EMVI positive rate detected by HR-MRI was analyzed. For further study,elderly RC patients were divided into lymph node metastasis group and non-lymph node metastasis group,and the influencing factors of lymph node metastasis were determined by univariate and multivariate logistic regression analysis. In addition,the ROC curve was used to analyze the predictive value of imaging technology for lymph node metastasis. Results:The positive proportion of HR-MRI scores in T4 stage was significantly higher than that in T3,T2 and T1 stages(P<0.05),and the positive proportion of HR-MRI scores in T3 stage was also higher than that in T2 and T1 stages (P>0.05). Among 184 RC patients,the patients were divided into two groups based on postoperative histopathological examination results:lymph node metastasis group (n=66) and non-lymph node metastasis group (n=118). Statistical analysis results showed that there were significant differences between the two groups in indicators such as T stage,tumor diameter,degree of differentiation,HR-MRI-EMVI positivity,vascular invasion and nerve invasion (P<0.05). Logistic regression analysis showed that the following factors were significant risk factors for lymph node metastasis in elderly RC patients(P<0.05):HR-MRI-EMVI positivity(OR=1.680,95％CI:1.243～2.272),vascular invasion(OR=1.919,95％CI:1.264～2.914),nerve invasion(OR=1.680,95％CI:1.162～2.429),T stage(OR=1.559,95％CI:1.235～1.968),tumor diameter(OR=1.791,95％CI:1.159～2.768) and degree of differentiation(OR=1.808,95％CI:1.030～3.173). ROC showed that the AUC of HR-MRI-EMVI positivity was 0.632 (95％CI:0.547～0.717),the AUC of vascular invasion was 0.809 (95％CI:0.743～0.875),the AUC of nerve invasion was 0.662 (95％CI:0.576～0.747),the AUC of differentiation degree was 0.607 (95％CI:0.519～0.694),the AUC of tumor diameter was 0.581 (95％CI:0.495～0.668),the AUC of T stage was 0.632 (95％CI:0.552～0.713),and the AUC of the regression analysis was 0.964 (95％CI:0.940～0.988),which was significantly higher than the AUC of any single diagnostic indicator,indicating that the regression model has good predictive value. Conclusion:HR-MRI tech-nology has high value in assessing EMVI in elderly RC patients,and T stage is significantly related to the positive rate of HR-MRI-EMVI. A number of clinicopathological factors have been identified as risk factors for lymph node metastasis,and considering these factors comprehensively can improve the prediction accuracy of lymph node metastasis. This suggests that HR-MRI technology combined with clinicopathological factors can be an effective means to assess the risk of lymph node metastasis in elderly patients with RC.
维普
万方数据