结合CT影像学及临床病理学特征评估直肠癌术前N分期  

Combining computer tomography and clinicopathological parameters for assessing rectal cancer node status

作　　者：郑二良 吴清彬[1] 邓祥兵[1] 周总光[1] 王自强[1] Zheng Erliang;Wu Qingbin;Deng Xiangbing;Zhou Zongguang;Wang Ziqiang.(Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院胃肠外科,成都610041

出　　处：《中华结直肠疾病电子杂志》2018年第3期218-222,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：四川省科技厅科技支撑计划(No.2016SZ0043)

摘　　要：目的探讨影响直肠癌N分期的CT影像学及临床病理学特征及其结合评估直肠癌术前N分期的作用。方法回顾性收集四川大学华西医院胃肠外科2010年7月至2013年7月间行直肠癌根治性切除术的300例中低位直肠癌患者的临床资料,根据术后病理将患者分为淋巴结阴性组(164例)和淋巴结阳性组(136例),分析影响淋巴结分期的CT影像学及临床病理特征,并分析其结合评估直肠癌术前N分期的作用。结果与淋巴结阴性组比较,淋巴结阳性组CEA较高(Z=-3.636,P<0.001)、肿瘤大小较大(t=-4.460,P<0.05),并且T分期较晚(Z=-4.895,P<0.05)、分化程度较低(Z=-4.861,P<0.05);两组间性别、年龄、CA199、肿瘤位置、手术方式、肿瘤分型的差异无统计学意义(P>0.05);此外淋巴结阳性组CT片淋巴结数目较多(Z=-5.134,P<0.001),平均长径(t=-6.462,P<0.05)、平均短径(t=-6.900,P<0.05)、最长长径(Z=-4.128,P<0.001)、最长短径(t=-7.183,P<0.05)以及CT值(Z=-6.560,P<0.001)均较大;淋巴结位置两组间差异有统计学意义(χ2=8.202,P<0.05)。多因素分析显示只有T分期、分化程度是淋巴结分期的独立影响因素。CT片指标与CEA、T分期、或分化程度结合可提高诊断特异性至80%以上。结论 T分期与分化程度是淋巴结分期的独立影响因素,CT片指标与CEA、T分期、或分化程度结合可提高诊断特异性至80%以上,但是敏感性和准确性仍较低,需要研究发现其他新的淋巴结分期方法。Objective To analyze parameters associated with rectal cancer N stage of computer tomography and clinicopathological characteristics and combination of both to evaluate it＇s role in rectal cancer preoperative N stage.MethodsClinical data of 300 patients with mid-low rectal cancer who underwent radical resection for rectal carcinoma at the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, from July 2010 to July 2013 were retrospectively collected. According to the postoperative pathologic lymph node status the patients were classiifed into 2 groups： group N-（n=164） and group N＋（n=136）. To analyze computer tomography image and clinicopathological characteristics which affects the stage of lymph nodes. And to analyze the combination of both to evaluate it＇s role in rectal cancer preoperative N stage.ResultsCompared with N- group, N＋ group had higher CEA （Z=-3.636,P〈0.001）, larger tumor size （t=-4.460,P〈0.05）, higher T staging （Z=-4.895,P〈0.05）, and higher differentiation grade （Z=-4.861,P〈0.05）. No significant difference was observed between two groups in terms of gender, age, CA199, tumor location, surgical procedure, and tumor type （P〉0.05）. Besides, N＋group had more numbers of lymph nodes （Z=-5.134,P〈0.001）, longer mean major axis diameter （t=-6.462,P〈0.05） and longer mean short axis diameter （t=-6.900,P〈0.05）, longer largest major axis diameter （Z=-4.128,P〈0.001） and longer largest short axis diameter （t=-7.183,P〈0.05）, and higher mean grey level （Z=-6.560,P〈0.001）. Lymph node location between two groups had significant difference （χ2=8.202, P〈0.05）. In multivariate analysis, only T staging and differentiation grade were the independent influence factors of lymph node staging. According to the combination results, combining image factors and CEA, T stage and differentiation grade can improve the diagnostic speciifcity to over 80%.Conclusions T staging and differentiation grade were identiif

关 键 词：直肠肿瘤 肿瘤转移 淋巴结分期 CT 临床病理特征 特异性 

分 类 号：R735.37[医药卫生—肿瘤]