直肠癌术前MRI对异时远处转移的预测价值评估  

Evaluation of prognostic value for preoperative MRI in predicting metachronous distant metastasis of rectal cancer

作　　者：刘欢欢[1] 汪登斌[1] 沈伟[2] 崔艳芬[1] 张财源[1] 崔龙[2] 傅佶泓[2] 

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海200092 [2]上海交通大学医学院附属新华医院肛肠外科,上海200092

出　　处：《放射学实践》2016年第6期506-510,共5页Radiologic Practice

基　　金：国家自然科学基金(No.81371621;No.81171389);上海市卫生系统优秀学科带头人培养计划(No.XBR2013110)

摘　　要：目的:探讨直肠癌术前MRI对异时远处转移的预测价值。方法:回顾性分析291例经手术病理证实为直肠癌患者治疗前的MR资料及随访资料,分析直肠癌MR征象与异时远处转移的相关性,分析异时远处转移的独立危险因素,并与病理结果进行对照。结果:291例患者中69例(23.7%)发生异时远处转移。单因素分析结果表明治疗前癌胚抗原(CEA)水平(P<0.001)、mrT分期(P=0.037),mrN分期(P<0.001)和环周切缘状态(mrCRM)(P<0.001)与直肠癌异时远处转移具有相关性。多因素分析结果显示CEA升高(P<0.001)、mrN2期(P=0.013)和mrCRM(P=0.001)受侵是直肠癌异时远处转移的独立危险因素。相比于mrN0患者,mrN1和mrN2期患者发生异时远处转移的危险比值比(OR值)分别为1.93和2.60。病理结果亦证实N分期为远处转移的危险因素。结论:直肠癌术前mrN分期是直肠癌异时远处转移的独立危险因素,有助于筛选远处转移的高危患者,从而采取个性化治疗,以提高预后。Objective：To investigate the prognostic value of preoperative MRI in predicting metachronous distant metastasis of rectal cancer.Methods：Pretreatment MRI and follow-up data of 291 patients with primary rectal cancer proved by histopathology were retrospectively analyzed.The correlations of MRI features and metachronous distant metastasis were evaluated.The independent risk factors of metachronous distant metastasis were analyzed.The histopathological results were used as the reference standard.Results：Among 291 patients,69patients（23.7%）were confirmed to have metachronous distant metastasis.Pretreatment CEA level（P〈0.001）,mrT staging（P=0.037）,mrN staging（P〈0.001）and circumferential resection margin（mrCRM）status（P〈0.001）were significantly correlated with distant metastasis in univariate analysis.Multiple-factor analysis showed elevated CEA level（P〈0.001）,mrN2staging（P=0.013）and mrCRM involvement（P=0.001）were independent risk factors for distant metastasis.Compared with odds ratios of metachronous distant metastasis in mrN0 staging,the odds ratios in mrN1 staging and mrN2 staging were 1.93 and 2.60 respectively.Pathological results also confirmed that N-staging was risk factor for distant metastasis.Conclusion：Preoperative mrN staging is an independent risk factor for metachronous distant metastasis in patient with rectal cancer,it can help to screen high-risk patients for individual treatment to improve prognosis.

关 键 词：磁共振成像 直肠肿瘤 淋巴结 肿瘤转移 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]