CE-MDCT征象、临床特征对胃癌腹膜转移的预测价值  

The Predictive Value Basing on CE-MDCT Signs and Clinical Features For Peritoneal Carcinomatosis of Gastric Cancer

作　　者：陈淑香 陈晓芳[1] 杜瑞宾[1] CHEN Shuxiang;CHEN Xiaofang;DU Ruibin(Fujian Medical University Provincial Clinical College,Department of Radiology,Fujian Province Hospital Jinshan Branch,Fuzhou,Fujian Province 350028,P.R.China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院/福建省立金山医院放射科,福州350028

出　　处：《临床放射学杂志》2021年第9期1755-1760,共6页Journal of Clinical Radiology

基　　金：福建医科大学启航基金项目资助(编号:2018QH1138)。

摘　　要：目的评估对比增强多排螺旋CT(CE-MDCT)征象、临床特征对胃癌腹膜转移的预测价值。方法回顾性分析经病理证实为胃癌的术前全腹部增强CT征象及临床、病理资料共336例(男237例,女99例),以手术、活检或腹腔游离癌细胞检查为金标准分为腹膜转移组(102例)与无腹膜转移组(234例)。构建临床特征、CT征象Logistic回归模型,分析对比其预测腹膜转移的效能。结果 (1)CE-MDCT征象模型:最终纳入模型的因素有胃癌原发灶最大径、病变静脉期强化程度、浆膜、腹膜及腹腔积液情况,其回归系数B分别为1.644、0.016、1.927、3.116、2.903,提示胃癌原发灶越大、病变强化程度越明显、有浆膜不光整、腹膜密度异常及腹腔积液的患者发生腹膜转移的可能性增加,相应的OR值分别为5.175、1.016、6.867、22.561、18.226;上述CT征象联合预测腹膜转移的ROC曲线下面积为0.938,敏感性为87.3%,特异性为90.2%。而两组的胃壁增厚层度及淋巴结肿大差异无统计学意义。(2)临床特征模型:最终纳入模型的因素为性别、CA125、CEA、CA724,CA125、CA724升高患者腹膜转移发生概率增加,OR值分别为13.998和7.88,而性别(男vs女)、CEA(+vs-)回归系数B为负值,OR值分别为0.531、0.174。临床特征模型ROC曲线下面积为0.654,敏感性为43.1%,特异性为77.4%。结论 CE-MDCT征象模型预测胃癌腹膜转移的效能较临床模型好,其准确性及敏感性、特异性均高于临床特征模型,特别是腹膜受累和腹腔积液是腹膜转移的独立预测因子。若能运用此模型对胃癌患者进行初步术前筛查,或可避免不必要或不适时的手术,对改善患者的预后有一定的意义。Objective To evaluate the predictive value of CE-MDCT signs and clinical features for peritoneal carcinomatosis of gastric cancer. Methods Retrospective analysis was performed on preoperative abdominal enhanced CT images and clinicopathological data of 336 cases patients(237 cases male and 99 cases female) with gastric cancer confirmed by pathology.The patients were divided into peritoneal metastatic group(102 cases) and non-peritoneal metastatic group(234 cases) according to surgery, biopsy or abdominal free cancerous cells.Logistic regression model of clinical features and CT signs was established to analyze and compare the efficacy of prediction of peritoneal metastasis. Results(1) CE-MDCT signs model: The factors eventually included in the model were the maximum diameter of primary focus, the degree of enhancement in the venous phase of the lesion, the situation of serous membrane, peritoneal and peritoneal effusion, with regression coefficients B of 1.644,0.016,1.927,3.116 and2.903 respectively, with the OR values of 5.175,1.016,6.867,22.561,18.226 respectively.These CT signs predict peritoneal metastasis with the area under the ROC curve of 0.938,The sensitivity and specificity were 87.3% and 90.2% respectively.While the gastric wall thickening and lymph node enlargement had not statistically significant.(2) Clinical features model: the probability of peritoneal metastasis was higher with the increasing of serumCA125、CA724,with OR values of 13.998 and 7.88 respectively.While the regression coefficients of serum CEA(+ vs-) and gender(male vs female) were negative, OR values were 0.531 and 0.174.ROC curve analysis of clinical features show that the area under the ROC curve was 0.654,the sensitivity and specificitywas 43.1%and 77.4%. Conclusion The CE-MDCT sign model was better than clinical model in predicting peritoneal metastasis of gastric cancer, with higher accuracy, sensitivity and specificity.In particular, peritoneal involvement and peritoneal effusion were independent predictors of peritoneal metas

关 键 词：胃癌腹膜转移 临床特征 体层摄影术 X线计算机 

分 类 号：R735.2[医药卫生—肿瘤]