大体肿瘤体积评估原发性肝癌放疗预后的价值及其截断值的获取  

The value of gross tumor volume in predicting the prognosis of primary liver carcinoma patients treated with radiotherapy and acquisition of cut-off value

作　　者：李业飞[1] 梁世雄[1] 黄华忠[1] 朱小东[1] 陈龙[1] 

机构地区：[1]广西医科大学附属肿瘤医院放射治疗科,广西南宁530021

出　　处：《中国癌症杂志》2010年第10期775-781,共7页China Oncology

基　　金：广西自然科学基金资助项目(No:0728198)

摘　　要：背景与目的:大体肿瘤体积(gross tumor volume,GTV)是原发性肝癌(primary liver carcinoma,PLC)放射治疗的预后因素,但其对肝癌放射治疗的预后价值有待进一步研究确立。本研究旨在探讨GTV和最大肿瘤直径(greatest tumor diameter,GTD)预测PLC放射治疗后生存时间的价值。方法:回顾性分析2000年1月—2006年12月间广西医科大学附属肿瘤医院收治的102例行放射治疗的Child-Pugh A级PLC患者资料。生存情况的单因素分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox比例风险回归模型;Spearman相关分析研究GTV、GTD与全肝体积间的相关性;受试者工作特征(receiver operator characteristic,ROC)曲线评估GTV、GTD预测Child-Pugh A级的PLC放射治疗后2年内死亡的准确性并在两者之间进行比较。结果:单因素分析提示UICC/AJCC T分期、门静脉癌栓(portal vein tumor thrombi,PVTT)、GTV、GTD影响预后;Cox回归分析提示GTV是独立的预后因子。GTV与全肝体积呈正相关(r=0.632,P<0.01),GTD与全肝体积呈正相关(r=0.432,P<0.01)。GTV、GTD预测Child-Pugh A级的PLC放射治疗后2年内死亡率的ROC曲线下面积分别为0.810和0.710;GTV的最佳判断界值为251.5 cm3,敏感度和特异度分别为83.64%和72.34%;GTD的最佳判断界值为7.75 cm,灵敏度和特异度分别为72.72%和65.96%。两者曲线下面积之间差异有统计学意义(P=0.016)。GTV≤251.5 cm3共43例,GTV>251.5 cm3共59例,2年生存率分别为74.5%和22.4%,差异有统计学意义(P<0.01)。GTD≤7.75 cm共46例,GTD>7.75 cm共56例,2年生存率分别为62.6%和27.9%,差异有统计学意义(P<0.01)。结论:GTV是独立预后因素,是简单有效的评价PLC放射治疗预后的指标。GTV和GTD判断预后的价值的能力差异有统计学意义,GTV判断预后的价值优于GTD。Background and purpose：Gross tumor volume（GTV） should be an independent prognostic factor affecting patients survival.However,the value of GTV in predicting the prognosis remains to be established.This study evaluated the prognostic significance of GTV and the greatest tumor diameter（GTD） in patients with Child-Pugh A primary liver carcinoma（PLC） who had been treated with radiotherapy.Methods：Having been treated with radiotherapy,102 Child-Pugh A PLC patients were enrolled in the Cancer Hospital of Guangxi Medical University from January of 2000 to December of 2006.Survival was determined through the Kaplan-Meier method and differences were assessed using the Log-rank test.Multivariate analysis was performed using the Cox proportional hazard regression model.The Spearman correlation analysis was used to determine the correlation coefficient.The predictive accuracy of GTV in determining the death of patients within 2 postoperative years was determined using the receiver operator characteristic curve（ROC） and was compared with the GTD.Results：Univariate analysis showed that the UICC/ AJCC T stage,portal vein tumor thrombi（PVTT）,GTD and GTV significantly influences the survival time of patients with PLC.Multivariate analysis showed that the GTV was a major independent prognostic factor for the patients with Child-Pugh A PLC treated with radiotherapy.The GTV correlated with the total liver volume（r=0.632,P0.01）,and so did the GTD（r=0.432,P0.01）.The areas under the ROC curves of GTV and GTD were 0.810 and 0.710,respectively.The optimum cut-off value of GTV was 251.5 cm3 with a sensitivity of 83.64% and specificity of 72.34%.The optimum cut-off value of GTD was 7.75 cm with a sensitivity of 72.72% and specificity of 65.96%.There was a significant difference between the areas under the receiver operator characteristic curve of the GTV and that of the GTD in predicting the 2-year survival rate（P=0.016）.The 2-year survival rates in the GTV ≤251.5 cm3 group and in the GTV251.5 cm3 gr

关 键 词：原发性肝癌 大体肿瘤体积 放疗 预后 受试者工作特征曲线 

分 类 号：R730.7[医药卫生—肿瘤] R735.7[医药卫生—临床医学]