经直肠超声评估局部进展期直肠癌新辅助治疗疗效的应用价值  

Clinical value of endorectal ultrasonography in predicting neoadjuvant treatment response for locally advanced rectal cancer

作　　者：陈丽梅 刘小银[1] 张文静 蒋清凌 覃斯 余俊丽[1] 王怡敏[1] 张峰 文艳玲[1] 刘广健[1] Chen Limei;Liu Xiaoyin;Zhang Wenjing;Jiang Qingling;Qin Si;Yu Junli;Wang Yimin;Zhang Feng;Wen Yanling;Liu Guangjian(Department of Medical Ultrasonics,the Sixth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院超声科,广州510655

出　　处：《中华超声影像学杂志》2019年第8期691-695,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨经直肠超声(endorectal ultrasonography,ERUS)在评价局部进展期直肠癌(locally advanced rectal cancer,LARC)新辅助放化疗(neoadjuvant chemoradiotherapy,NCRT)疗效中的应用价值。方法回顾分析我院99例接受了NCRT及全直肠系膜切除术,且NCRT前后均接受了ERUS检查的LARC患者。记录NCRT治疗前(ERUS1)及NCRT治疗后(ERUS2)的肿瘤长度、厚度并计算长度和厚度缩小率。根据最终病理肿瘤退缩分级(tumor regression grade,TRG)分为反应良好组(47例)和反应不良组(52例),完全缓解(pathological complete response,pCR)组(25例)和非pCR组(74例)。比较不同组间各参数的差异;采用Spearman相关系数法分析各参数与TRG分级的相关性;采用ROC曲线计算各参数对疗效评估的截断值并评价其诊断效能。结果患者ERUS2的肿瘤长度及厚度较ERUS1明显缩小(均P<0.05)。反应良好组ERUS2的长度和厚度小于反应不良组,且长度和厚度缩小率大于反应不良组(均P<0.05)。pCR组ERUS2的长度和厚度小于非pCR组,且长度和厚度缩小率大于非pCR组(均P<0.05)。ERUS2长度、厚度与TRG分级呈正相关(r=0.577,0.605;均P<0.01);长度和厚度缩小率与TRG分级呈负相关(r=-0.681,-0.598;均P<0.01)。ROC曲线显示长度及厚度缩小率预测反应良好的截断值分别为41.34%、46.46%,对应的AUC面积为0.843、0.796,敏感性为74.5%、70.2%,特异性为76.9%、80.8%;而预测pCR的截断值为57.36%、58.52%,对应的AUC面积为0.851、0.895,敏感性为68.0%、76.0%,特异性为94.6%、93.2%。结论直肠肿瘤治疗前后长度及厚度的变化与NCRT的疗效具有良好相关性,通过ERUS测算肿瘤长度及厚度缩小率对预测LARC患者反应良好与pCR具有较高的准确性。Objective To assess the value of endorectal ultrasonography(ERUS) in predicting the pathological response to neoadjuvant chemoradiotherapy(NCRT) for locally advanced rectal cancer(LARC). Methods Ninety-nine patients with LARC received NCRT and total mesorectal excision in our hospital were retrospectively analyzed. The maximum length and thickness of rectal tumor were measured by ERUS both before NCRT(ERUS1) and after NCRT following sugery(ERUS2), and the length and thickness reduction rate were calculated. The patients were classified into good responder group(n=47) and poor responder group(n=52), or pathological complete response(pCR) group(n=25) and non-pCR group (n=74) according to pathological tumor regression grade(TRG). The differences of various parameters were compared between groups. The correlations between these parameters and TRG grading were analyzed by Spearman correlation analysis. The ROC curve was used to evaluate the diagnostic efficacy of the parameter. Results The length and thickness of ERUS2 were significantly shorter than that of ERUS1(all P<0.05). The length and thickness of ERUS2 in good responder group were shorter than those in poor responder group, while the length and thickness reduction rate were higher than those in poor responder group with significant difference(all P<0.05). The length and thickness of ERUS2 in pCR group were shorter than those in non-pCR group, while the length and thickness reduction rate were higher than those in non-pCR group with significant difference(all P<0.05). The length and thickness of ERUS2 were positively correlated with TRG grading(r=0.577, 0.605;all P<0.01) and the length and thickness reduction rate were negatively correlated with TRG grading(r=-0.681,-0.598;all P<0.01). ROC curve showed the cut-off value of the length and thickness reduction rate to predict good responder were 41.34%, 46.46%, with corresponding AUC areas of 0.843, 0.796, sensitivity of 74.5%, 70.2%, and specificity of 76.9%, 80.8%, respectively. ROC curve showed the cut-off valu

关 键 词：超声检査 经直肠 直肠癌 新辅助治疗 肿瘤退缩分级 

分 类 号：R735.37[医药卫生—肿瘤] R445.1[医药卫生—临床医学]