CT体积测量在进展期胃癌患者新辅助化疗疗效评价中的应用价值研究  

Prediction of pathologic response to neoadjuvant chemotherapy in advanced gastric cancer by MDCT:Results of a prospective trial

作　　者：刘炜[1] 李小毅[2] 薛华丹[1] 孙昊[1] 王萱[1] 陈钰[1] 苏佰燕[1] 金征宇[1] 钟定荣[3] 王沄[1] 张晓娜[1] 张云庆[1] 秦明伟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院放射科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《癌症进展》2010年第5期420-424,共5页Oncology Progress

摘　　要：目的探讨多层螺旋CT体积测量技术对于进展期胃癌患者新辅助化疗疗效评价的应用价值。方法对31例胃镜病理确诊胃癌的患者(男性24例,女性7例,平均年龄57岁)进行化疗前64层螺旋CT增强扫描,所有患者接受胃癌新辅助化疗(Folfox 6方案)3个疗程,化疗后再行64层螺旋CT增强扫描,1周内所有患者手术切除肿瘤,并取得病理作对照,分为病理无效组和有效组。以门脉期重建图像测量肿瘤厚度及体积,分析肿瘤厚度和体积变化与病理评价疗效的关系。结果 CT测量肿瘤厚度较测量肿瘤体积重复性差。CT肿瘤厚度减少率与病理分级的相关性r=0.540(P=0.002)。CT肿瘤体积减少率与病理分级的相关系数为0.570(P=0.001),呈中度相关。如果将肿瘤体积减少率37.2%作为的评价化疗有效的阈值,其预测病理评价有效的敏感性是73%,特异性80%。结论 CT测量肿瘤厚度减少率和体积减少率可以帮助预测进展期胃癌患者化疗疗效,但CT肿瘤体积测量更客观,与化疗疗效的相关性更好。Objective To investigate the utility of CT volumetry in the assessment of early response during neoadju- vant chemotherapy in patients with resectable advanced gastric cancer （ AGC ）. Methods A total of 31 patients with AGC （stage T2/3 and N0/1 and M0） were prospectively enrolled in our study. There were 7 women and 24 men with a mean age of 57 years （range 34-80 years）. Contrast-enhanced CT was obtained after gastric distention with water before and 8 weeks after the initiation of the neoadjuvant chemotherapy. Pre- and post-chemotherapy maximal thickness and vol- ume of the primary gastric tumor were measured using a 3D software by two independent radiologists. Interobserver varia- bility was determined with the Spearman rank correlation. The percentage thickness and volume reduction rates were calcu- lated and correlated with the histopathologic grades of regression using Spearman correlation test. The differentiation of responders from non-responders was assessed with receiver operating characteristic （ROC） analysis. Results The interobserver variability for thickness measurements was higher than that for the volumetric measurements. The percentage thick- ness reduction rate was significantly correlated with the histopathologic grades of regression （ r -- 0. 540, P = 0. 002 ）, while the correlation factor was significantly higher in the percentage volume reduction rate （ r = 0. 570, P = 0. 001 ）. When the cutoff value of the percentage volume reduction rate of the gastric tumor was set to be 37.2%, a sensitivity of 73% and a specificity of 80% were achieved. Conclusion Tumor thickness measurement and volumetry based on MDCT can help predict pathologic response following neoadjuvant chemotherapy in patients with AGC. CT volumetry is more standardized and shows better correlation with histopathologic tumor regression.

关 键 词：体层摄影术 X线计算机 胃癌 新辅助化疗 病理反应 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]