食管鳞状细胞癌胸椎功能不全性骨折与放射治疗的相关性  

Relationship Between Radiotherapy and Thoracic Vertebral Insufficiency Fractures in Patients with Esophageal Squamous Cell Carcinoma

作　　者：吴兴强 张天悦 冯钰玲 李春平[1] 陈天武[1] 李睿[1] WU Xingqiang;ZHANG Tianyue;FENG Yuling;LI Chunping;CHEN Tianwu;LI Rui(Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]川北医学院附属医院放射科,四川南充637000

出　　处：《中国医学影像学杂志》2022年第7期697-702,共6页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金(81801674);四川省科技厅应用基础研究(2021YJ0242)。

摘　　要：目的探讨食管鳞状细胞癌患者发生胸椎功能不全性骨折与接受放射治疗的相关性。资料与方法回顾性分析2016年3月—2018年4月川北医学院附属医院经病理证实为食管鳞状细胞癌的239例患者的临床和影像资料。根据术后随访期间胸椎是否发生功能不全性骨折,将患者分为骨折组20例与非骨折组219例。用Logistic回归分析发生胸椎功能不全性骨折的危险预测因素,比较放射治疗前后照射野内胸椎椎体的CT值,评估骨折组放射治疗患者的放射治疗照射野与胸椎骨折部位的一致性。结果骨折组患者接受放射治疗的比例高于非骨折组[90.0%(18/20)比65.3%(130/219);χ^(2)=7.297,P=0.007]。单因素Logistic回归分析发现,放射治疗(OR=6.162,P=0.016)和年龄≥65.5岁(OR=3.291,P=0.015)是食管癌患者发生术后胸椎功能不全性骨折的危险因素。多因素Logistic回归模型在调整年龄因素后,放射治疗仍是食管癌患者胸椎骨折的危险因素(OR=6.105,P=0.018)。放射治疗患者照射野内胸椎椎体放射治疗后CT值较放射治疗前明显降低[(118.07±34.30)Hu比(145.92±32.69)Hu;t=7.381,P<0.001],且胸椎功能不全性骨折的发生部位和放射治疗的照射野范围具有较高的一致性(Kappa=0.70,P<0.001)。结论食管鳞状细胞癌患者胸椎功能不全性骨折与是否接受放射治疗相关,是发生术后胸椎功能不全性骨折的独立危险因素。CT能观察到放射治疗前后椎体密度及形态学改变。Purpose To investigate the relationship between radiotherapy and thoracic vertebral insufficiency fractures(IF)in patients with esophageal squamous cell carcinoma.Material and Methods A total of 239 cases diagnosed as esophageal squamous cell carcinoma in the Affiliated Hospital of North Sichuan Medical College from March 2016 to April 2018 were retrospectively enrolled,the clinical and image data of all patients were retrospectively reviewed and analyzed.All patients were divided into two groups,including fracture group(n=20)and non-fracture group(n=219)according to thoracic vertebral IF during follow-up.Logistic regression analysis was performed to explore the risk predictive factors of thoracic vertebral IF.The CT value of the thoracic vertebral in the irradiation field before and after radiotherapy was compared.The consistency of the radiotherapy radiation field and the thoracic fracture site in fracture group was analyzed.Results The percentage of patients in fracture group received radiotherapy was significantly higher than those in non-fracture group[90.0%(18/20)vs.65.3%(130/219);χ^(2)=7.297,P=0.007].The univariate Logistic regression analysis demonstrated that radiotherapy(OR=6.162,P=0.016)and age≥65.5 years(OR=3.291,P=0.015)were the risk factors for thoracic IF in patients with esophageal cancer.Radiotherapy was still a risk factor for thoracic fracture in patients with esophageal cancer(OR=6.105,P=0.018)in multivariate logistic regression model adjusted by age.The average of the thoracic vertebral in the radiation field was significantly lower than that of before radiotherapy[(118.07±34.30)Hu vs.(145.92±32.69)Hu;t=7.381,P<0.001].The high consistency was demonstrated in location of thoracic fractures and the radiation field range of radiotherapy(Kappa=0.70,P<0.001).Conclusion Thoracic vertebral IF in patients with esophageal squamous cell carcinoma are related to radiotherapy,which is the independent risk factor for postoperative thoracic vertebral IF.The vertebral density and morphology abnormaliti

关 键 词：食管鳞状细胞癌 放射治疗 胸椎功能不全性骨折 病理学 外科 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]