高分辨率MRI检查预测T3期直肠癌对新辅助治疗效果的研究  

Efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer

作　　者：孙轶群[1] 童彤[1] 章真[1] 蔡三军[1] 顾雅佳[1] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放射诊断科,上海200032

出　　处：《中华消化外科杂志》2015年第6期479-483,共5页Chinese Journal of Digestive Surgery

基　　金：上海市科委计划项目（13140902103）;上海市科委引导项目（124119a0201）;上海市卫生局青年项目（20124y099）

摘　　要：目的 探讨高分辨率MRI检查预测T3期直肠癌新辅助治疗效果的可行性.方法 回顾性分析2010-2012年复旦大学附属肿瘤医院收治的108例T3期直肠癌患者的临床资料,治疗前高分辨率MRI检查图像评估内容包括肿瘤TNM分期、肿瘤浸润直肠系膜深度（mrT3亚分期）、直肠系膜筋膜是否受累、肿瘤直径及肿瘤下缘距肛缘距离.患者新辅助治疗后均予手术切除病灶.分别采用术后病理学再分期及肿瘤退缩评分系统评估病灶对新辅助治疗的效果.多分类等级资料采用单因素分析,多因素分析采用Logistic回归分析.结果 新辅助治疗后,T3a、b、c期患者疗效好者比例分别为61.5％（16/26）、36.9％（24/65）、11.8％（2/17）.病理学再分期单因素分析结果表明：T3亚分期,N分期及肿瘤直径是影响新辅助治疗效果的可能因素（x2=50.474,30.985,8.318,P＜0.05）.病理学再分期多因素分析结果发现：T3b期是影响新辅助治疗效果的独立危险因素（OR =4.473,95％可信区间：2.003～9.991,P＜0.05）.而以肿瘤退缩评分系统（TRG）作评估新辅助治疗效果的方式时,T3亚分期、N分期、直肠系膜筋膜受累情况、肿瘤直径和肿瘤下缘距肛缘距离与新辅助治疗效果无明确相关性（x2=6.264,6.159,2.949,2.189,6.335,P＞0.05）.结论 新辅助治疗前高分辨率MRI检查显示的T3亚分期能够预测直肠癌对新辅助治疗的效果.Objective To explore the efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.Methods The clinical data of 108 patients with T3 rectal cancer who were admitted to Shanghai Cancer Center of Fudan University from 2010 to 2012 were retrospectively analyzed.The TNM stage of tumor,extramural depth of tumor invasion （mrT3 stage）,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor were the main items of evaluation using the high-resolution MRI.A total of 108 patients underwent surgical resection of tumor after neoadjuvant chemoradiation therapy.The tumor complete response after neoadjuvant chemoradiation therapy was evaluated by tumor node metastasis （TNM） stage and tumor regression grade （TRG）.The categorical data and multivariate analysis were done by the single factor analysis of variance （ANOVA） and Logistic regression analysis.Results The positive response rate of the T3a,T3b and T3c in the patients were 61.5% （16/26）,36.9% （24/65） and 11.8% （2/17） after neoadjuvant chemoradiation therapy,respectively.The mrT3,mrN and tumor diameter were the potential factors affecting response of neoadjuvant chemoradiation therapy by the univariate analysis of pathological restaging （x2 =50.474,30.985,8.318,P 〈 0.05）.The mrT3 was an independent risk factor affecting response of neoadjuvant chemoradiation therapy by the multivariate analysis of pathological restaging （OR =4.473,95 % confidence interval：2.003-9.991,P 〈 0.05）.There was no significant difference between the mrT3 stage,N stage,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor before therapy and the response after neoadjuvant chemoradiation therapy based on the tumor regression grade（TRG） （x2 =6.264,6.159,2.949,2.189,6.335,P 〉 0.05）.Conclusion The mrT3 in patients undergoing high-resolution MRI before neoadjuvant chemo

关 键 词：直肠肿瘤 T3期 新辅助放化疗 磁共振成像 预测 

分 类 号：R735.37[医药卫生—肿瘤]