DCE-MRI定量参数联合循环肿瘤细胞对预测食管鳞癌病理分级的价值  

Value of DCE-MRI combined with circulating tumor cells in predicting pathological grades of esophageal squamous cell carcinoma

作　　者：邢文群[1] 路双 张宏凯[2] 贾争艳 秦建军 曲金荣[2] XING Wen-qun;LU Shuang;ZHANG Hong-kai(Department of Radiology,the Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省肿瘤医院胸外科,郑州450000 [2]河南省肿瘤医院放射科,郑州450000 [3]中国医学科学院北京协和医学院国家癌症中心胸外科,北京100005

出　　处：《放射学实践》2021年第9期1081-1088,共8页Radiologic Practice

基　　金：国自然科学基金面上项目(81972802);河南省自然科学基金面上项目(182300410355);河南省卫生计生科技创新型人才“51282”工程领军人才(20160913)·。

摘　　要：目的:分析动态对比增强MRI(DCE-MRI)定量参数、循环肿瘤细胞(CTCs)与食管鳞癌病理分级的相关性,探讨其预测食管鳞癌病理分级的价值。方法:回顾性搜集经活检病理证实为食管鳞癌的62例患者,入组患者术前均行食管MRI扫描及CTCs检测,得到食管DCE-MRI定量参数[包括容积转移常数(K trans)、速率常数(K ep)、血管外细胞外间隙容积比(V e)、血浆分数(V p)、对比剂最大浓度值(MAX Conc)、时间信号曲线最大斜率值(MAX Slope)、增强后时间信号曲线下面积(AUC)]及CTCs总数及各亚型数目。采用CanPatrol TM CTC-二代分离富集技术将CTCs分为上皮型、间质型和混合型。分析术后病理标本得到食管鳞癌的病理分级(高、中、低分化),采用单因素方差分析及Kruskal-Wallis H检验得到组间差异有统计学意义的有效参数。采用受试者工作特征(ROC)曲线、二元logistic回归分析及Z检验分析比较有效参数及联合因素对低分化食管鳞癌的诊断效能。结果:62例食管鳞癌中高分化5例,中分化38例,低分化19例。DCE-MRI定量参数、CTCs与食管鳞癌病理分级均呈正相关。不同病理分级间的K trans、K ep、Vp、AUC、Max Slope、间质型CTCs、CTCs总数间差异均具有统计学意义(P值均<0.05)。间质型CTCs、K trans、K ep、Vp、Max Conc、AUC、Max Slope诊断低分化食管鳞癌的ROC曲线下面积分别为0.673、0.820、0.744、0.745、0.718、0.711、0.695,DCE-MRI参数中K trans的诊断效能最佳,优于间质型CTCs。DCE-MRI有效参数联合间质型CTCs诊断低分化食管鳞癌的ROC曲线下面积为0.913,优于任意单一因素的诊断效能。结论:食管鳞癌DCE-MRI定量参数及间质型CTCs均可预测食管鳞癌病理分级,且DCE-MRI定量参数的预测价值优于间质型CTCs,联合DCE-MRI定量参数及间质型CTCs预测低分化食管鳞癌的效能优于任意单一因素。Objective:To analyze the correlation between dynamic contrast-enhanced MRI(DCE-MRI)parameters,circulating tumor cells(CTCs),and the pathological grades of esophageal squamous cell carcinoma(ESCC),and explore their ability in predicting the pathological grade of ESCC.Methods:Sixty-two ESCC patients confirmed by biopsy and pathology participated in this retrospective study.All patients underwent esophageal MRI scan and CTC analysis before surgery to obtain esophageal DCE-MRI quantitative parameters[including volume transfer constant(K trans),exchange rate constant(K ep),extravascular extracellular volume fraction(V e),plasma volume fraction(Vp),max concentration(MAX Conc),maximum slope of decrease(MAX Slope),area under the time-signal curve(AUC)],and the total CTCs and the number of each subtype.CTCs were divided into epithelial,interstitial and mixed types by using the CanPatrol TM CTC.The postoperative pathological specimens were analyzed for the pathological grade(high,medium,and poorly differentiated).The one-way ANOVA and Kruskal-Wallis H test were used to obtain effective parameters with statistically significant differences between groups.Receiver operating characteristic curve(ROC),binary logistic regression analysis,and Z test were used to compare the diagnostic efficacy of effective parameters and combined approaches for poorly differentiated ESCC.Results:Among 62 cases of ESCC,5 cases were well-differentiated,38 patients were moderately differentiated,and 19 cases were poorly differentiated.DCE-MRI quantitative parameters and CTCs were positively correlated with the pathological grade of ESCC.The differences in K trans,K ep,Vp,AUC,Max Slope,interstitial CTCs,and total CTCs among different pathological grades were statistically significant(all P<0.05).The area under the ROC(AUROC)of interstitial CTCs,K trans,K ep,Vp,Max Conc,AUC,and Max Slope for the diagnosis of poorly differentiated ESCC were 0.673,0.820,0.744,0.745,0.718,0.711,and 0.695,respectively.K trans has the best diagnostic efficacy among DCE-MR

关 键 词：食管肿瘤 食管鳞癌 磁共振成像 循环肿瘤细胞 病理分级 

分 类 号：R735.1[医药卫生—肿瘤] R445.2[医药卫生—临床医学]