多排螺旋CT检查对食管胃结合部腺癌新辅助化疗后临床分期评估的应用价值  

Application value of multi-detector computed tomography evaluating the clinical staging of adenocarcinoma of the esophagogastric junction after neoadjuvant chemotherapy

作　　者：王之龙[1] 唐磊[1] 李子禹[2] 李晓婷[1] 付佳[1] 陕飞[2] 张燕[2] 孙应实[1] 季加孚[2] Wang Zhilong;Tang Lei;Li Ziyu;Li Xiaoting;Fu Jia;Shah Fei;Zhang Yan;Sun Yingshi;Ji Jiafu(Department of Radiology,Peking University Cancer Hospital ＆ Institute,Key laboratory of Carcinogenesis and Translational Research（Ministry of Education）,Belling 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室、医学影像科,100142 [2]北京大学肿瘤医院胃肠肿瘤中心,100142

出　　处：《中华消化外科杂志》2018年第8期861-868,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81371715）;北京市优秀人才培养资助（2017000021469G279）;首都临床特色应用研究与成果推广（Z161100000516060）;北京市医管局青苗计划（QML20161102）

摘　　要：目的：探讨多排螺旋CT检查对食管胃结合部腺癌（AEG）新辅助化疗后临床分期评估的应用价值。方法：采用回顾性横断面研究方法。收集2016年1月至2018年4月北京大学肿瘤医院收治的46例行新辅助化疗AEG患者的临床病理资料。患者新辅助化疗前、新辅助化疗后手术前2周行多排螺旋CT检查，并根据冠状位测量和轴位公式法判断肿瘤中心与食管胃结合部（EGJ）交界线的距离；患者新辅助化疗后行胃癌根治性切除＋D2淋巴结清扫术，病理科医师复阅术后大体标本测量AEG的肿瘤中心与EGJ交界线的距离。按照美国癌症联合会（AJCC）第8版TNM分期系统确定新辅助化疗后临床T分期（ycT分期）、N分期（ycN分期）和病理学T分期（ypT分期）、N分期（ypN分期）。根据美国国立综合癌症网络 （NCCN）标准确定肿瘤退缩分级（TRG）。观察指标：（1）AEG新辅助化疗后CT检查情况。（2）AEG 新辅助化疗后临床分期情况。（3）AEG术后病理学检查情况。（4）AEG术后病理学分期情况。（5）AEG新辅助化疗后临床分期准确率。（6）AEG新辅助化疗前后CT检查图像变化与病理学反应的关系。计数资料采用绝对数或百分比表示，组间比较采用x2检验，等级资料比较采用非参数检验。结果：（1）AEG新辅助化疗后CT检查情况：46例AEG患者中，5例CT检查冠状位图像示肿瘤全貌及EGJ交界线，CT检查轴位图像示EGJ管壁增厚，病变全层不均匀强化，浆膜面不光滑；直接测量肿瘤中心与EGJ交界线距离均〈 2 cm，此5例均按食管癌分期。41例患者CT冠状位图像无法在一张图像中同时显示肿瘤全貌与EGJ交界线，CT检查轴位图像示EGJ管壁增厚，病变全层不均匀强化，浆膜面不规则形态；使用公式法计算为负值者27例，按食管癌分期，计算为正值者14例，按胃癌分期。（2）AEG新辅助化疗后临床分期情况：46�Objective：To investigate the multidetector computed tomography （MDCT） evaluating the clinical staging of adenocarcinoma of the esophagogastric junction （AEG） after neoadjuvant chemotherapy. Methods：The retrospective crosssectional study conducted. The clinicopathological data of 46 AEG patients who were admitted to the Peking University Cancer Hospital between January 2016 and April 2018 were collected. All patients underwent MDCT before and after neoadjuvant chemotherapy and at preoperative 2 weeks, the distance between tumor center and boundary of esophagogastric junction （EGJ） was judged through coronal measured values and axial formula method. Patients underwent radical resection of gastric cancer ＋ D2 lymph node dissection after neoadjuvant chemotherapy, pathologists reviewed the distance between center of AEG and boundary of EGJ, T staging （ycT） and N staging （ycN） of clinical staging, T staging （ypT） and N staging （ypN） of pathological staging after neoadjuvant chemotherapy were determined according to TNM staging of American Joint Committee on Cancer （AJCC） （8th edition）, and tumor regression grading （TRG） was determined according to the criterion established by National Comprehensive Cancer Network. Observation indicators： （1） CT examination after neoadjuvant chemotherapy; （2） clinical staging after neoadjuvant chemotherapy; （3） postoperative pathological examination; （4） postoperative pathological staging; （5）accuracy of clinical staging after neoadjuvant chemotherapy; （6）relationship between imaging changes of CT examination and pathological reactions. Count data were described as absolute number or percentage, and comparisons among groups were analyzed by the chisquare test. Comparisons of ordinal data were analyzed by the nonparametric test. Results：（1） CT examination after neoadjuvant chemotherapy： 5 of 46 AEG patients, coronal images of CT showed whole tumor and boundary of EGJ, axial images of CT showed EGJ wall thicke

关 键 词：食管胃结合部肿瘤 腺癌 新辅助治疗 多排螺旋CT 病理学 分期 

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