表观扩散系数差值对鼻咽癌同步放、化疗短期疗效预测价值  

Value of the Difference of Apparent Diffusion Coefficient in Predicting the Short-Term Outcome in Patients with Nasopharyngeal Carcinoma After Concurrent Chemoradiotherapy

作　　者：何渝 刘勤敏 刘丽娟[1] 陈东明 金观桥[1] HE Yu;LIU Qinmin;LIU Lijuan(Department of Radiology,Guangxi Medical University Cancer Hospital,Nanning,Guangxi Province 530021,P.R.China)

机构地区：[1]广西医科大学附属肿瘤医院放射科,广西影像医学临床医学研究中心,广西临床重点专科(医学影像科),广西医科大学附属肿瘤医院优势培育学科(医学影像学科),南宁530021

出　　处：《临床放射学杂志》2021年第8期1475-1479,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:81260334、81760533)。

摘　　要：目的探讨扩散加权成像(DWI)中表观扩散系数(ADC)差值对鼻咽癌同步放、化疗短期疗效的预测价值。方法回顾性分析本院2014年1月至2018年12月经鼻咽镜活检病理证实为鼻咽癌且进行同步放、化疗的109例初治患者的影像资料。所有患者治疗前均行DWI检查。测量肿瘤治疗前最大层面ADC最大值、最小值,并计算ADC差值(ADC最大值-ADC最小值)。参考实体肿瘤疗效评价标准(RECIST 1.1)将患者分为临床完全缓解组(CR)和非完全缓解组(non-CR)。采用受试者工作特征(ROC)曲线分析评价ADC差值及其联合TNM分期的预测效能。采用决策曲线分析(DCA)进一步验证研究结果。结果ADC差值预测CR的敏感度、特异度分别为74.3%、62.2%,ROC曲线下面积(AUC)为0.696,其最佳阈值为0.627。单因素分析结果提示ADC差值、肿瘤最大单径线、临床TNM分期与鼻咽癌预后相关联(P均<0.005)。多因素分析结果显示ADC差值(OR=0.26,P=0.006)和TNM分期(OR=0.36,P=0.008)是影响鼻咽癌同步放、化疗预后的独立因素。以ADC差值0.627为临界值将样本分为两组,ADC差值<0.627发生CR的概率较ADC差值≥0.627提高了74%。TNM分期联合ADC差值提高了鼻咽癌CR的预测效能(敏感度、特异度分别为65.7%、71.6%,AUC为0.759)。DCA进一步证实联合预测的优势。结论ADC差值是鼻咽癌同步放、化疗后CR独立预测因子之一,联合TNM分期提高了CR预测效能。ADC差值可作为鼻咽癌预后的预测指标,有助于指导临床鼻咽癌患者治疗方案的制定。Objective To explore the value of the difference of apparent diffusion coefficient(ADC)in predicting the short-term outcome in patients with nasopharyngeal carcinoma(NPC)after concurrent chemoradiotherapy(CCRT).Methods Imaging data of 109 patients with biopsy-confirmed NPC and treated with concurrent chemoradiotherapy from January 2014 to December 2018 were collected retrospectively.All the patients performed diffusion weighted imaging(DWI)scanned for pre-treatment evaluation.Maximum and minimum ADC values of the NPC lesions were measured based on the largest sectionof the tumor,and the difference of ADC value was calculated.Patients were divided into complete response(CR)and non-complete response(non-CR)group,according to the Response Evaluation Criteria in Solid Tumors(RECIST)Version 1.1.Receiver operating characteristic(ROC)curve analysis was used to evaluate the efficacy of the difference of ADC and its combination with TNM staging.Using decision curve analysis(DCA),the result was replicated further.Results The sensitivity of the difference of ADC value was 74.3%,and the specificity was 62.2%.In ROC curve analysis,the cut-off point for the difference of ADC was 0.627 and the area under the ROC curve(AUC)was 0.696.In univariate analysis,the difference of ADC value,the maximum diameter,and TNM staging significantly correlated with the short-term outcome(P<0.05).The multivariate analysis showed that the difference of ADC value(OR=0.26;P=0.006)and TNM staging(OR=0.36;P=0.008)also significantly correlated with the short-term outcome.Setting the difference of ADC value of 0.627 as the threshold value,the study cohort was divided into two groups.Compared with the difference of ADC value≥0.627,the probability of CR with ADC value difference<0.627 increased by 74%.After integrating the difference of ADC value and TNM staging,the predicting efficacy was improved(sensitivity,65.7%;specificity,71.6%;AUC;0.759).Conclusion The difference of ADC value was an independent prognostic factor for NPC patients treated with CCRT

关 键 词：鼻咽癌 扩散加权成像 表观扩散系数 预测模型 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.63[医药卫生—诊断学]