弥散加权成像对鼻咽癌新辅助化疗早期疗效评估的价值  

The value of diffusion weighted imaging in evaluating the early efficacy of neoadjuvant chemotherapy for nasopharyngeal carcinoma

作　　者：许强 陈晓丹 何庄贞 陈兴发[1] 陈韵彬[1] XU Qiang;CHEN Xiaodan;HE Zhuangzhen;CHEN Xingfa;CHEN Yunbin(Department of Radiotherapy,Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院放诊科,福建福州350014

出　　处：《中国现代医生》2022年第19期6-10,共5页China Modern Doctor

基　　金：福建省卫计委青年科研课题(2018–1–14)。

摘　　要：目的探讨弥散加权成像(diffusion weighted imaging,DWI)在评估及预测鼻咽癌新辅助化疗早期疗效的价值。方法选取2018年9月~2020年12月于福建省肿瘤医院就诊的鼻咽癌患者70例为研究对象,根据新辅助化疗方案将其分为吉西他滨联合铂类药物(gemcitabine combined with platinum drugs,GEM)组(35例)和紫杉醇联合铂类药物(paclitaxel combined with platinum drugs,PTX)组(35例),测量患者治疗前、化疗第4天(D4)、化疗第1周期末(D21)和化疗第2周期末(D42)的表观扩散系数(apparent diffusion coefficient,ADC),并比较两组间ADC及其变化值的差异。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析各参数对新辅助化疗早期疗效的预测效能。结果D21和D42时,GEM组患者的治疗有效率显著高于PTX组(P<0.05);治疗前,GEM组患者的ADC显著小于PTX组(P=0.02),D4时,GEM组患者ΔADC及%ADC均显著大于PTX组(均P<0.05),化疗第2周期结束,GEM组内有效组患者D4、D21时的ADC、ΔADC、%ADC均显著大于非有效组(均P<0.05),PTX组内有效组患者D4时的ΔADC、%ADC,D21时的ADC、ΔADC、%ADC均显著大于非有效组(均P<0.05)。ROC曲线结果显示,GEM组和PTX组中D4时的%ADC曲线下面积分别为0.760、0.756,敏感度分别为80.0%、92.7%,特异性分别为75.0%、66.7%。结论DWI对早期评估和预测鼻咽癌新辅助化疗疗效具有较高的临床价值。Objective To investigate the value of diffusion weighted imaging(DWI)in evaluating and predicting the early efficacy of neoadjuvant chemotherapy for nasopharyngeal carcinoma.Methods Seventy patients with nasopha-ryngeal cancer treated in Fujian Cancer Hospital from September 2018 to December 2020 were selected as the study subjects,and divided into gemcitabine combined with platinum drugs(GEM)group(n=35)and paclitaxel combined with platinum drugs(PTX)group(n=35).The apparent diffusion coefficients(ADC)of the patients were measured before treatment,on the fourth day of chemotherapy(D4),at the end of the first cycle of chemotherapy(D21)and at the end of the second cycle of chemotherapy(D42),and the differences of ADC and its change values between the two groups were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of each parameter on the early efficacy of neoadjuvant chemotherapy.Results At D21 and D42,the effective rate of GEM group was significantly higher than PTX group(P<0.05).Before treatment,the ADC of GEM group was significantly lower than that of PTX group(P=0.02).At D4,theΔADC and%ADC of GEM group were significantly higher than those of PTX group(all P<0.05).At the end of the second cycle of chemotherapy,in GEM group,ADC,ΔADC and%ADC of effective group at D4 and D21 were significantly higher than those of non–effective group(all P<0.05),in PTX group,ΔADC,%ADC at D4 and the ADC,ΔADC,and%ADC at D21 of effective group were sig-nificantly higher than those of non–effective group(all P<0.05).ROC curve showed that the area under the curve of%ADC at D4 in GEM group and PTX group was 0.760 and 0.756,sensitivity was 80.0%and 92.7%,and specifici-ty was 75.0%and 66.7%,respectively.Conclusion DWI has high clinical value in early evaluation and prediction of neoadjuvant chemotherapy for nasopharyngeal carcinoma.

关 键 词：弥散加权成像 鼻咽癌 新辅助化疗 疗效 

分 类 号：R445[医药卫生—影像医学与核医学]