新辅助放化疗前后局部进展期直肠黏液腺癌与非黏液腺癌的MRI影像学差异  

MRI differences between locally advanced rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma before and after neoadjuvant chemoradiotherapy

作　　者：周杰[1] 李彪 令狐羽 张文怡 曹务腾[1] Zhou Jie;Li Biao;Linghu Yu;Zhang Wenyi;Cao Wuteng(Department of Radiology,Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院放射科,广东省结直肠盆底疾病研究重点实验室,广州510655

出　　处：《中华放射学杂志》2021年第11期1141-1146,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(82001765);广东省基础与应用基础研究基金(2019A1515010889)。

摘　　要：目的探讨新辅助放化疗(NCR)前后局部进展期直肠黏液腺癌与非黏液腺癌的MRI影像学差异。方法采用回顾性队列研究方法,收集2016年10月至2019年10月中山大学附属第六医院收治的165例行NCR联合手术治疗的局部进展期直肠腺癌患者临床及影像学资料,其中直肠黏液腺癌组36例,非黏液腺癌组129例。基于MRI评估两组患者NCR前后的图像特征,包括肿瘤长径、肿瘤厚度、肿瘤下缘距肛缘距离、T分期、N分期、直肠系膜筋膜(MRF)受累、腹膜反折受累。采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验比较两组患者NCR前MRI特征的差异和NCR后MRI特征变化的差异。对照术后病理结果,分析两组患者NCR后MRI再分期的准确性。结果NCR前,黏液腺癌与非黏液腺癌组患者肿瘤长径差异有统计学意义(P=0.044),肿瘤下缘距肛缘距离、肿瘤厚度、MRI T分期、N分期、MRF受累、腹膜反折受累差异均无统计学意义(P均>0.05)。NCR后,非黏液腺癌患者在肿瘤下缘距肛缘的距离缩小值、肿瘤长径缩小值、厚度缩小值及T降期率明显高于黏液腺癌组(P均<0.05),黏液腺癌的N降期率高于非黏液腺癌组(P=0.008)。与病理T分期相比,NCR后MRI均高估了黏液腺癌与非黏液腺癌患者的T分期(P均<0.001),同时高估了黏液腺癌的N分期,差异有统计学意义(P=0.001)。结论直肠黏液腺癌与非黏液腺癌对NCR的敏感性不同,非黏液腺癌患者更得益于NCR的疗效。NCR后MRI对直肠黏液腺癌与非黏液腺癌再分期的准确性仍有待提高。Objective To investigate the MRI differences between locally advanced rectal mucinous adenocarcinoma and non-mucinous adenocarcinoma before and after neoadjuvant chemoradiotherapy(NCR).Methods A retrospective cohort study was conducted to collect the clinical and imaging data of 165 patients with locally advanced rectal adenocarcinoma treated by NCR combined with surgery from October 2016 to October 2019 in the Sixth Affiliated Hospital of Sun Yat-sen University,36 cases were rectal mucinous adenocarcinoma and 129 cases were non-mucinous adenocarcinoma.The image features of the two groups before and after NCR were evaluated based on MRI,including the length and thickness of the tumor,the distance from the lower edge of the tumor to the anal edge,T stage,N stage,involvement of mesorectal fascia(MRF)and peritoneal reflux.The difference of NCR and the change of MRI characteristics after NCR were compared by independent sample t test,Mann-Whitney U test or χ^(2) test.The accuracy of MRI re-staging after NCR was evaluated according by postoperative pathological staging results.Results Before NCR,there was significant difference in length of tumor between mucinous adenocarcinoma and non-mucinous adenocarcinoma groups(P=0.044),there was no significant difference in the distance from the lower edge of the tumor to the anal edge,thickness of the tumor,T stage,N stage,involvement of MRF and peritoneal reflux(all P>0.05).After NCR,in patients with non-mucinous adenocarcinoma,the distance reduction from the lower edge of the tumor to the anal edge,the length reduction of the tumor,the thickness reduction of the tumor,the T-stage decline rate were significantly higher than those in the mucinous adenocarcinoma group(all P<0.05).The N-stage decline rate of mucinous adenocarcinoma was higher than that in non-mucinous adenocarcinoma group(P=0.008).After NCR,MRI overestimated T staging of patients with both mucinous adenocarcinoma and non-mucinous adenocarcinoma compared with pathological T-stage(P<0.001).In patients with mucinou

关 键 词：直肠肿瘤 腺癌 黏液 磁共振成像 新辅助放化疗 

分 类 号：R735.37[医药卫生—肿瘤]