高分辨率MRI联合列线图模型预测直肠癌环周切缘阳性危险因素  

High-resolution MRI combined with nomogram model predicts the risk factors of positive circumferential resection margin in rectal cancer

作　　者：周瑾 宫希军[2] 彭传勇 吴宗山 孟婷 ZHOU Jin;GONG Xijun;PENG Chuanyong;WU Zongshan;MENG Ting(Department of Medical Imaging,Lu’an Hospital Affiliated to Anhui Medical University,Lu’an,Anhui Province 237000,China;Department of Radiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学附属六安医院医学影像科,安徽六安237000 [2]安徽医科大学第二附属医院放射科,安徽合肥230000

出　　处：《实用放射学杂志》2023年第12期1971-1975,共5页Journal of Practical Radiology

基　　金：安徽医科大学校科学研究基金资助项目(2020xkj193)。

摘　　要：目的探讨高分辨率磁共振成像(HR-MRI)联合列线图模型分析预测直肠癌术前环周切缘(CRM)阳性危险因素的临床价值。方法回顾性分析经手术病理证实的107例直肠癌患者的术前资料。应用SPSS 25.0软件对直肠癌CRM阳性潜在的危险因素进行单因素统计学分析,筛选出有差异的危险因素后,进行多变量logistic回归分析对危险因素类别进行分类。使用R软件(4.2.0版本)建立列线图模型,绘制曲线对模型进行评估,通过受试者工作特征(ROC)曲线展示特异度和敏感度,曲线下面积(AUC)评估区分度,校准曲线评估校准度,决策曲线分析(DCA)评估临床获益,并对模型行自举法(Bootstrap)内部验证。结果肿瘤位于直肠下段[P=0.01,比值比(OR)=8.71]、肿瘤垂直于肠管的最大长径(≥18.86 mm±5.32 mm)(P=0.01,OR=1.24)、有壁外血管受侵(EMVI)(P<0.01,OR=0.03)以及有肠系膜周围淋巴结转移(P=0.01,OR=0.15)是直肠癌CRM阳性的独立危险因素。以此建立的列线图训练集AUC为0.921(敏感度0.83,特异度0.93)、验证集AUC为0.912(敏感度0.87,特异度0.82),Bootstrap内部验证法校正AUC为0.92、一致性指数(C指数)为0.92,模型具有较好的区分度、校准度和临床获益价值。结论HR-MRI联合列线图模型预测出肿瘤位于直肠下段、肿瘤垂直于肠管的最大长径≥(18.86±5.32)mm、有EMVI和有肠系膜周围淋巴结转移与直肠癌CRM阳性密切相关。Objective To investigate the clinical value of high-resolution magnetic resonance imaging(HR-MRI)combined with nomogram model in predicting the risk factors of positive circumferential resection margin(CMR)in rectal cancer surgery.Methods A retrospective analysis was conducted on preoperative data from 107 rectal cancer patients who underwent surgery and were confirmed by pathology.SPSS 25.0 software was used for univariate statistical analysis of potential risk factors for positive CRM,and after independent risk factors were selected,multivariate logistic regression analysis was performed to classify the risk factor categories.R software(4.2.0 version)was used to establish the nomogram model,and a curve was drawn to evaluate the model.The receiver operating characteristic(ROC)curve was used to show specificity and sensitivity,the area under the curve(AUC)was used to evaluate discriminative ability,the calibration curve was used to evaluate calibration,the decision curve analysis(DCA)was used to evaluate clinical benefit,and the model was internally validated using the Bootstrap method.Results Tumor located in the lower rectum[P=0.01,odds ratio(OR)=8.71],maximum diameter of tumor perpendicular to the intestinal tube(≥18.86 mm±5.32 mm)(P=0.01,OR=1.24),extramural vascular invasion(EMVI)(P<0.01,OR=0.03),and mesorectal lymph node metastasis(P=0.01,OR=0.15)were independent risk factors for positive CRM in rectal cancer.The nomogram model established based on these factors had a training set AUC of 0.921(sensitivity 0.83,specificity 0.93),a validation set AUC of 0.912(sensitivity 0.87,specificity 0.82),a Bootstrap internal validation corrected AUC of 0.92,and a consistency index(C-index)of 0.92,indicating good discriminative ability,calibration,and clinical benefit value.Conclusion HR-MRI combined with nomogram model predicted that tumor located in the lower rectum,maximum diameter of tumor perpendicular to the intestinal tube≥(18.86±5.32)mm,EMVI,and mesorectal lymph node metastasis are closely related to positiv

关 键 词：直肠癌 磁共振成像 高分辨率 环周切缘 列线图 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]