多层螺旋CT对胃癌术前分期及肿瘤最长径的评估价值  

Value of the preoperative TNM staging and the longest tumor diameter measurement of gastric cancer evaluated by MSCT

作　　者：赵群[1] 李勇[1] 胡子龙[1] 檀碧波[1] 杨沛刚[1] 田园[1] 

机构地区：[1]河北医科大学第四医院外三科,石家庄050011

出　　处：《中华胃肠外科杂志》2015年第3期227-231,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81072033）;河北省自然科学基金（H2013206311）

摘　　要：目的：探讨多层螺旋CT（MSCT）在胃癌术前分期和肿瘤最长径测量中的应用价值。方法回顾性分析2012年1月1日至2013年3月15日间在河北医科大学第四医院行MSCT检查并经手术病理证实的153例胃癌患者的临床资料，以MSCT为基础进行术前TNM分期和肿瘤最长径测量，并与病理结果进行一致性比较。结果 MSCT评估胃癌术前T分期的准确率为71．2％（109／153），与术后病理T分期一致性较好（Kappa＝0．566）；评估胃癌术前N分期的准确率为47．7％（73／153），与术后病理N分期一致性不理想（Kappa＝0．284）；评估胃癌术前M分期的准确率为98．7％（151／153），与术后M分期一致性满意（Kappa＝0．893）。MSCT评估胃癌术前TNM分期的总体准确率为66．7％（102／153），与术后TNM分期一致性较好（Kappa＝0．573）。53例获有效测量的胃癌患者术前MSCT和术后病理测量的肿瘤最长径分别为（68．8±40．6） mm和（64．2±36．2） mm，差异无统计学意义（P＝0．969）。结论 MSCT对胃癌术前TNM分期的评价及最长径的测量较为准确，可为胃癌的术前分期及新辅助疗效评价提供可靠依据，但对淋巴结转移情况的评估能力较差。Objective To explore the value of MSCT in the preoperative TNM staging and the longest tumor diameter measurement （RESIST standard） of gastric cancer. Methods Clinical data of 153 consecutive patients with biopsy-confirmed gastric carcinoma who were preoperatively evaluated with enhanced MSCT scanning in our hospital from January 2012 to March 2013 were retrospectively analyzed. Consistency comparison was performed between preoperative TNM staging and the longest tumor diameter measurement and histopathological findings. Results T-staging consistency of Kappa value was 0.566, and accuracy was 71.2%. N-staging consistency of Kappa value was 0.284, and accuracy was 47.7%. The Kappa value of M-staging consistency was 0.893, and accuracy was 98.7%. The overall accuracy of TNM staging consistency was 66.7% （102/153） with a Kappa value of 0.573. Effective measurement of the longest cancer diameter was carried out in 53 patients. There was no significant difference between preoperative longest tumor diameter acquired by MSCT and postoperative tumor measurement [（68.8±40.6） mm vs. （64.2±36.2） mm, P=0.969]. Conclusion MSCT is accurate in preoperative TNM staging and longest tumor diameter measurement of gastric cancer compared with postoperative pathological examination , and can provide reliable evidence for preoperative staging and neoadjuvant therapy evaluation of gastric cancer , but it is unfavorable to evaluate the lymph node metastasis.

关 键 词：胃肿瘤 多层螺旋CT 术前分期 肿瘤最长径 

分 类 号：R735.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]