基于核磁共振和鳞状细胞癌抗原预测早期宫颈鳞癌辅助放疗的模型  

Predictive Model of Adjuvant Radiotherapy for Early Cervical Squamous Cell Carcinoma Based on Nuclear Magnetic Resonance and Squamous Cell Carcinoma Antigen

作　　者：李锦巍 付秀虹[1] 王冲[1] 翟静静 吕净上[1] 刘晴 梁金玉 齐晓臻 LI Jinwei;FU Xiuhong;WANG Chong;ZHAI Jingjing;L Jingshang;LIU Qing;LIANG Jinyu;QI Xiaozhen(Obstetrics and Gynecology Department,Luohe Central Hospital,Luohe 462000,China)

机构地区：[1]漯河市中心医院妇科,河南漯河462000

出　　处：《河南医学研究》2024年第4期599-602,共4页Henan Medical Research

基　　金：河南医学科技攻关计划联合共建项目(LHGJ20191409)。

摘　　要：目的建立一个基于核磁共振和鳞状细胞癌抗原(SCCA)模型,预测早期宫颈鳞癌是否需要术后辅助放疗。方法收集2018—2021年医院收治的67例早期宫颈鳞癌(ⅠB1、ⅠB2、ⅡA1)患者的临床资料,回顾性分析病灶大小、浸润深度、组织分化程度、年龄、SCCA、表观弥散系数(ADC)值、人乳头瘤病毒(HPV)亚型与术后辅助放疗的关系。通过单因素及多因素分析,筛选出影响术后辅助放疗的独立危险因素。应用受试者工作特征(ROC)曲线求得独立危险因素的截断值,进一步构建预测模型。结果单因素分析后发现,病灶大小(P<0.001)、浸润深度(P=0.001)、组织分化程度(P=0.002)、SCCA(P<0.001)、ADC值(P<0.001)影响术后辅助放疗,二元logistic回归多因素分析后发现,病灶大小(OR=1.201,P=0.021)、SCCA(OR=1.608,P=0.033)、ADC值(OR=0.013,P=0.043)是影响辅助放疗的独立危险因素。利用ROC求得截断值分别为:SCCA=4.84μg·L^(-1),病灶=27 mm,ADC=0.907×10^(-3)mm^(2)·s^(-1)。当同时满足任意2个指标时,术后辅助放疗的比率达94.7%以上。结论肿瘤≥27 mm、ADC值≤0.907×10^(-3)mm^(2)·s^(-1)、SCCA≥4.84μg·L^(-1)可以作为判断辅助放疗的指标,若同时满足任意2个指标,辅助放疗的可能性明显增加,此时应慎重考虑治疗方式,尽量避免根治性手术及辅助放疗双重治疗模式带来的严重并发症的发生。Objective To establish a model based on nuclear magnetic resonance imaging and squamous cell carcinoma antigen(SCCA)to predict whether early cervical squamous cell carcinoma requires postoperative adjuvant radiotherapy.Methods The clinical data of 67 patients with early cervical squamous cell carcinoma(ⅠB1,ⅠB2,ⅡA1)admitted to the hospital from^(2)018 to 2021 were collected.The relationship between the lesion size,depth of invasion,degree of tissue differentiation,age,SCCA,apparent diffusion coefficient(ADC)value,human papillomavirus(HPV)subtype and postoperative adjuvant radiotherapy were retrospectively analyzed.Through univariate analysis and multi-factor analysis,independent risk factors that affect postoperative adjuvant radiotherapy were screened out.The receiver operating characteristic(ROC)curve was used to obtain the cut-off point of independent risk factors,and the prediction model was further constructed.Results After univariate analysis,it was found that lesion size(P<0.001),depth of invasion(P=0.001),degree of tissue differentiation(P=0.002),SCCA(P<0.001)and ADC value(P<0.001)affected postoperative adjuvant radiotherapy.After binary logistic regression multivariate analysis,it was found that the size of the lesion(OR=1.201,P=0.021),SCCA(OR=1.608,P=0.033),ADC value(OR=0.013,P=0.043)were independent risk factors affecting adjuvant radiotherapy.The cut-off points obtained by ROC were,SCCA level=4.84μg·L^(-1),lesion size=27 mm,ADC value=0.907×10^(-3)mm^(2)·s^(-1),respectively.When any two indicators were met at the same time,the proportion of postoperative adjuvant radiotherapy was more than 94.7%.Conclusion Tumor size≥27 mm,ADC value≤0.907×10^(-3)mm^(2)·s^(-1),SCCA level≥4.84μg·L^(-1)can be used as indicators for judging adjuvant radiotherapy.If any two indicators are met at the same time,the possibility of adjuvant radiotherapy is obvious.At this time,the treatment method should be carefully considered,and the serious complications caused by the dual treatment mode of radical surgery

关 键 词：宫颈鳞癌 辅助放疗 核磁共振 表观弥散系数 鳞状细胞癌抗原 

分 类 号：R737.33[医药卫生—肿瘤]