MRI评估直肠壁外静脉浸润对预测局部进展期直肠癌术前放化疗敏感性的价值  

MRI-detected extramural venous invasion for predicting the response to preoperative chemoradiatiotherapy in locally advanced rectal cancer

作　　者：谢海艇[1] 陈明[2] 周鑫[1] 王浩[3] 张云凯[1] 曾焕红 傅卫[1] 

机构地区：[1]北京大学第三医院普外科,100191 [2]北京大学第三医院放射科, 100191 [3]北京大学第三医院肿瘤放疗科,100191

出　　处：《中华普通外科杂志》2016年第3期193-196,共4页Chinese Journal of General Surgery

基　　金：首都临床特色应用研究资助项目

摘　　要：目的 研究术前放化疗（preoperative chemoradiatiotherapy,pre-CRT）前,MRI评估直肠壁外静脉浸润（MRI-detected extramural venous invasion,mrEMVI）对预测pre-CRT敏感性的价值.方法 回顾性分析2013年2月至2014年12月在北京大学第三医院诊断为局部进展期直肠癌并进行pre-CRT的47例患者的临床资料.将pre-CRT前mrEMVI情况按浸润程度分为0～4分,其中3～4分记为mrEMVI阳性;将mrEMVI阳性者再按浸润静脉的大小分为大、中、小三种类型.最后采用Fisher精确检验,比较不同浸润程度及不同类型的mrEMVI患者对pre-CRT敏感性. 结果 mrEMVI阳性共26例,阳性率为55％;其中浸润程度3分和4分者分别为18例、8例;小、中和大静脉浸润者分别为16、6和4例.mrEMVI阳性组中,pre-CRT后获得肿瘤消退分级（tumor regression grade,TRG）0～1级比率明显低于mrEMVI阴性组（P=0.019）.浸润程度4分和大静脉浸润组其TRG 0 ～1率均低于mrEMVI阴性组（P=0.038和0.017）.结论 mrEMVI浸润程度为4分或有大静脉浸润者提示直肠癌对术前放化疗（pre-CRT）的敏感性较差.Objective To evaluate the efficacy of MRI-detected extramural venous invasion （mrEMVI） in predicting tumor responses to preoperative chemoradiatiotherapy （pre-CRT） in patients with locally advanced rectal cancer （LARC）.Methods The clinicopathological data,tumor response and mrEMVI information of 47 LARC from February 2013 to December 2014 were retrospectively collected.mrEMVI was given 0-4 score according to the degree,3-4 score were defined as mrEMVI positive;patients with mrEMVI positive were divided into three subgroups according to vascular size （large,middle and small）.Association between different mrEMVI subgroup and tumor response was analyzed using Fisher exact test.Result 26 patients were mrEMVI positive.18 and 8 patients scored 3 and 4 for mrEMVI positive,respectively;16,6 and 4 patients were small,middle and larger vessels of mrEMVI positive,respectively.Patients with mrEMVI positive had less TRG 0-1 than mrEMVI negative （P =0.019）.Scored 4 and larger vessel of mrEMVI positive had less TRG 0-1 than mrEMVI negative （P =0.038 and 0.017）.Conclusions mrEMVI positive score 4 or larger vessel predict poor tumor response to pre-CRT in patients of locally advanced rectal cancer.

关 键 词：直肠肿瘤 化放疗 辅助 肿瘤转移 预测 

分 类 号：R735.37[医药卫生—肿瘤]