术前CT对胰腺癌可切除性评估及切缘阳性多因素分析研究  

The Preoperative Evaluation Value of CT for Pancreatic Cancer Resectability and Multivariate Analysis in Predicting R0 Resection

作　　者：杨志浩[1] 韩懿静 徐华南 殷亚科 YANG Zhihao;HAN Yijing;XU Huanan(Department of Radiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院放射科,450052 [2]郑州大学第一附属医院肝胆外科,450052

出　　处：《临床放射学杂志》2022年第6期1060-1064,共5页Journal of Clinical Radiology

基　　金：河南省科技厅科技攻关项目(编号:212102310664)。

摘　　要：目的对比分析不同术前CT可切除性分组胰腺癌患者的肿瘤边缘阴性(R0)切除率,并评估可切除组胰腺癌患者切缘阳性相关因素。方法回顾性分析120例经手术及病理证实胰腺癌患者的临床影像资料。根据其胰周血管侵犯情况及美国国家综合癌症网络(NCCN)诊疗指南及专家共识制定的胰腺癌可切除标准,分为可切除组、潜在可切除组和不可切除组;以手术和病理结果为参照,评估并对比各组R0切除率。可切除组胰腺癌患者,对切缘阳性的相关因素进行单因素分析和多因素Logistics回归分析。结果120例手术胰腺癌患者术后切缘阴性R074例,切缘阳性R1~246例。术前CT可切除性分组评估包括可切除组81例,潜在可切除组25例,不可切除组14例;各组R0切除率分别为72.8%、52.0%、14.3%,可切除组R0切除率最高(P<0.001);各组间年龄、性别、部位、分化程度、CA19-9水平均无统计学差异。81例可切除组胰腺癌患者中,术后切缘阴性59例,切缘阳性22例。单因素分析显示门静脉(PV)及肠系膜上静脉(SMV)毗邻、肿瘤最大径是影响可切除胰腺癌切缘的因素,多因素分析结果显示合并PV及SMV毗邻、肿瘤最大径>4 cm是可切除胰腺癌患者中切缘阳性的独立危险因素(P=0.004,0.008)。合并PV及SMV毗邻的校正比值比(OR)值是5.7,无PV及SMV毗邻的R0切除率是83.0%;肿瘤最大径>4 cm的校正OR值是16.9,肿瘤最大径<2 cm R0切除率是83.3%,肿瘤最大径2~4 cm R0切除率是76.4%,肿瘤最大径>4 cm R0切除率是25.0%。结论胰腺癌不同术前CT可切除性分组其R0切除率不同;可切除组中,合并PV及SMV毗邻、肿瘤最大径>4 cm是影响胰腺癌切缘阳性的独立危险因素。Objective To evaluate the diagnostic performance of CT in the assessment of pancreatic cancer resectability and to investigate the relevant features predict R0 resection by multivariate analysis.Methods The clinical data and CT imaging data of 120 patients with surgical and pathologic confirmation of pancreatic cancer were retrospectively analyzed.According to the clinical practice guidelines of national comprehensive cancer network(NCCN)and expert consensus,the pancreatic cancer were divided into resectable,borderline resectable and unresectable.With the results of operation and pathology as standard,the R0 resection rates of each group were assessed.In resectable group,the relevant factors with R0 resection was evaluated by univariate analysis and multivariate logistic regression analysis.Results In 120 pancreatic cancer patients who underwent surgery(74 cases R0 resection and 46 cases R1-2 resection),the number of resectable group,borderline resectable group and unresectable group were 81,25 and 14,respectively;and the corresponding R0 resection rates were 72.8%,52.0%,and 14.3%(P<0.001).The age,gender,location,differentiated degree and the level of CA19-9 had no significant difference among groups.Among 81 cases in resectable group,53 cases R0 resection and 28 cases R1-2 resection were included.At univariate analysis,PV or SMV abutment and tumor size were significantly associated with R0 resection(P=0.004,0.008).Multivariate analysis showed that with PV or SMV abutment(adjusted odds ratio=5.7)and tumor size larger than 4 cm(adjusted odds ratio=16.9)were independently associated with margin-positive resection.The R0 resection rates were 83.0%for resectable pancreatic cancer without PV or SMV abutment,83.3%for resectable tumors2 cm or smaller,76.4%for resectable tumors size 2 cm to 4 cm,25.0%for tumors larger than 4 cm.Conclusion R0 resection rates vary in different resectability groups.With PV or SMV abutment and tumors larger than 4 cm are independent risk factor with margin-positive resection in patients for

关 键 词：体层摄影术 X线计算机 胰腺癌 可切除性 R0切除 

分 类 号：R735.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]