基于影像组学预测局部晚期直肠癌患者新辅助放化疗疗效的价值  

Value of Imaging Genomics in Predicting Effect of Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer

作　　者：鲁中祥 刘怡君 石磊[2] 段耀星 贾应梅 杨熊飞 王建凯[5] 朱成章 杜斌斌 LU Zhong-xiang;LIU Yi-jun;SHI Lei;DUAN Yao-xing;JIA Ying-mei;YANG Xiong-fei;WANG Jian-kai;ZHU Cheng-zhang;DU Bin-bin(First Clinical Medical College of Gansu University of Traditional Chinese Medicine,Lanzhou,Gansu 730000;Department of Pharmacy,Gansu Provincial People's Hospital,Lanzhou,Gansu 730000;Gansu Clinical Medical Research Center for Anorectal Diseases,Lanzhou,Gansu 730000;Department of Imaging,Gansu Provincial People's Hospital,Lanzhou,Gansu 730000;Department of Radiotherapy,Gansu Provincial People's Hospital,Lanzhou,Gansu 730000;First Clinical Medical College of Lanzhou University,Lanzhou,Gansu 730000)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省人民医院药剂科,甘肃兰州730000 [3]甘肃省肛肠疾病临床医学研究中心,甘肃兰州730000 [4]甘肃省人民医院影像科,甘肃兰州730000 [5]甘肃省人民医院放疗科,甘肃兰州730000 [6]兰州大学第一临床医学院,甘肃兰州730000

出　　处：《中国肛肠病杂志》2024年第5期1-7,共7页Chinese Journal of Coloproctology

基　　金：甘肃省自然科学基金项目(22YF7FA097)。

摘　　要：目的:基于新辅助放化疗前后的磁共振成像(MRI)多序列图像,建立新辅助放化疗(nCRT)疗效的预测模型.方法:回顾2020年1月至2023年5月甘肃省人民医院收治的经临床病理证实为局部晚期直肠癌(T3-4N+M0)且行nCRT的患者资料,根据nCRT治疗效果分为缓解组和非缓解组,分析MRI多序列影像学特征.同时,构建单序列成像模型和多序列联合成像模型,采用受试者工作特征(ROC)曲线评估单序列成像模型和多序列联合成像模型预测nCRT疗效的效果;并采用决策曲线分析法(DCA)评价各模型的临床应用价值.结果:T2WI+DWI多序列联合成像模型的曲线下面积(AUC)为0.919,明显高于T2WI、DWI单序列成像模型.多序列联合成像预测模型的校正能力和判别能力均优于单序列成像模型,敏感度为0.958,特异度为0.800,95%CI(0.79,1.00).结论:基于多序列联合成像的预测效果模型对nCRT疗效的预测效果优于单序列成像预测模型.Objective To establish the predictive model for the efficacy of neoadjuvant chemoradiothera-py(nCRT)based on the multi-sequence magnetic resonance imaging(MRI)images before and after nCRT.Methods The clinical and pathological data of patients with locally advanced rectal cancer(T3-4N+M0)who underwent nCRT at Gansu Provincial People's Hospital from January 2020 to May 2023 were retrospectively analyzed.According to the efficacy of nCRT,the patients were divided into remission group and non-remission group,and the multi-sequence imaging features of MRI were analyzed.At the same time,the single-sequence imaging model and multi-sequence combined imaging model were construc-ted,and the predictive effect of the single-sequence imaging model and multi-sequence combined imaging model on the efficacy of nCRT was evaluated by using the receiver operating characteristic(ROC)curve.Decision curve analysis(DCA)was used to evaluate the clinical application value of each model.Results The area under the curve(AUC)of the T2WI+DWI multi-sequence combined imaging model was 0.919,which was significantly higher than that of the T2WI+DWI single-sequence imaging model.The calibration ability and discriminatory ability of the multi-sequence combined imaging predictive model were better than those of the single-sequence imaging model,with a sensitivity of 0.958 and a specificity of 0.800,and a 95%confidence interval(0.79,1.00).Conclusion The predictive model based on multi-se-quence combined imaging is superior to the single-sequence imaging model in predicting the efficacy of nCRT.

关 键 词：磁共振成像 直肠癌 新辅助放化疗 肿瘤反应 预测模型 

分 类 号：R735.37[医药卫生—肿瘤]