经直肠三维超声在直肠癌新辅助放化疗后病理完全缓解评估中的价值  

Value of three-dimensional endorectal ultrasound in the assessment of complete pathologic response after neoadjuvant chemoradiation therapy in patients with rectal cancer

作　　者：金鑫 陈东[1] 陈海涛[1] 张映贤 钏志睿 罗晓茂[1] JIN Xin;CHEN Dong;CHEN Haitao;ZHANG Yingxian;CHUAN Zhirui;LUO Xiaomao(Department of Ultrasound Medicine,the Third Affiliated Hospital of Kunming Medical University,Kunming 650106,China)

机构地区：[1]昆明医科大学第三附属医院超声医学科,昆明市650106

出　　处：《临床超声医学杂志》2021年第9期655-658,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨经直肠三维超声(3D-ERUS)在局部晚期直肠癌新辅助放化疗(NCRT)后病理完全缓解评估中的应用价值。方法98例局部晚期直肠癌患者均于标准NCRT方案后行全直肠系膜切除术,于首次入院1周内和术前NCRT后1周内分别行3D-ERUS,记录肿瘤累及长径、累及最厚径、累及肠圈及可疑淋巴结最长径。根据病理结果分为病理完全缓解组20例(pCR组)和非缓解组78例(non-pCR组),比较两组3D-ERUS参数的差异。采用Spearman相关分析法分析3D-ERUS参数与肿瘤退缩分级的相关性;绘制受试者工作特征(ROC)曲线分析各参数对NCRT后病理完全缓解的评估价值。结果NCRT后,肿瘤累及长径、累及最厚径、累及肠圈及可疑淋巴结最长径均较放化疗前明显缩小(均P<0.05)。NCRT后pCR组和non-pCR组肿瘤累及长径、累及最厚径、累及肠圈、累及长径变化率、累及最厚径变化率、累及肠圈变化率和血流分级变化率比较差异均有统计学意义(均P<0.05)。NCRT后肿瘤累及长径、累及最厚径、累及肠圈与肿瘤退缩分级均呈正相关(r=0.336、0.403、0.339,均P<0.05);累及长径变化率、累及最厚径变化率、累及肠圈变化率、血流分级变化率与肿瘤退缩分级均呈负相关(r=-0.407、-0.435、-0.408、-0.235,均P<0.05)。ROC曲线分析显示累及长径变化率的截断值为29%,曲线下面积AUC为0.791;累及最厚径变化率的截断值为44%,AUC为0.824;累及肠圈变化率的截断值为33%,AUC为0.782;血流分级变化率的截断值为0,AUC为0.653。结论3D-ERUS在局部晚期直肠癌NCRT后病理完全缓解评估中具有重要价值。Objective To investigate the value of three-dimensional endorectal ultrasound(3D-ERUS)in evaluating complete pathologic response after preoperative neoadjuvant chemoradiation therapy for locally advanced rectal cancer.Methods Ninety-eight patients with locally advanced rectal cancer underwent total mesorectal excision after standard neoadjuvant chemoradiation therapy(NCRT)were selected.3D-ERUS was performed within one week of first admission and one week after preoperative NCRT,the involved length,involved thickness,involved intestinal circle and the longest diameter of suspected lymph node of tumor were recorded.According to the pathological results,20 cases were divided into complete pathologic response group(pCR group)and 78 cases were divided into non-response group(non-pCR group),and the difference of 3D-ERUS parameters between the two groups were compared.The correlation between 3D-ERUS parameters and tumor regression grade were analyzed by Spearman correlation method.ROC curve was drawn to evaluate the value of each parameter for pathological complete response after NCRT.Results After NCRT,the involved length,the involved thickness,the involved intestinal circle,and the longest diameter of suspected lymph nodes of tumor were significantly reduced compared with those before NCRT(all P<0.05).The pCR group and the non-pCR group had significant differences in the involved length,the involved thickness,the involved intestinal circle,the involved length change rate,the involved thickness change rate,the involved intestinal circle change rate,and the blood flow change rate after NCRT(all P<0.05).There were positive correlation between the involved length,the involved thickness,the involved intestinal circle and tumor regression grade(r=0.336,0.403,0.339,all P<0.05),a negative correlation between the involved length change rate,the involved thickness change rate,the involved intestinal circle change rate,the blood flow change rate and tumor regression grade after NCRT(r=-0.407,-0.435,-0.408,-0.235,all P<0.05).ROC

关 键 词：超声检查 三维 经直肠 直肠肿瘤 恶性 新辅助放化疗 肿瘤退缩分级 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]