MRI对局部进展期直肠癌患者术前新辅助放化疗后病理完全反应的预测效能  

Efficacy of MRI in predicting pathological complete response after preoperative neo-adjuvant chemoradiotherapy in patients with locally advanced rectal cancer

作　　者：周舒玲 施常备 任娟[2] 杨勇 赵娓娓 王璇[2] 杨胜利 ZHOU Shuling;SHI Changbei;REN Juan;YANG Yong;ZHAO Weiwei;WANG Xuan;YANG Shengli(Imaging Department,Xi'an Hospital of Traditional Chinese Medicine,Shaanxi Xi'an 710016,China;Department of Radiotherapy,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China;Shaanxi Provincial Tumor Hospital,Shaanxi Xi'an 710061,China)

机构地区：[1]西安市中医医院影像科,陕西西安710016 [2]西安交通大学第一附属医院放疗科,陕西西安710061 [3]陕西省肿瘤医院,陕西西安710061

出　　处：《现代肿瘤医学》2024年第13期2405-2410,共6页Journal of Modern Oncology

摘　　要：目的:探讨磁共振成像(magnetic resonance imaging,MRI)对局部进展期直肠癌(locally advanced rectal cancer,LARC)患者术前新辅助放化疗(neo-adjuvant chemoradiotherapy,NCRT)后病理完全反应(pathological complete response,pCR)的预测效能。方法:回顾性纳入2019年11月至2023年10月在陕西省西安市某三甲医院的92例LARC患者,并依据NCRT后手术病理结果分为pCR组(n=21)和非pCR组(n=71)。所有患者NCRT前、后均实施直肠MRI常规扫描及弥散加权成像(diffusion-weighted imaging,DWI)检查,收集其临床特征与影像学特征,运用单因素、多因素Logistic回归分析确定pCR相关影响因素,并基于多因素Logistic回归分析绘制受试者工作特征(receiver operating characteristic,ROC)曲线,运用曲线下面积(area under curve,AUC)分析影像学特征对pCR预测价值。结果:单因素分析结果显示:pCR组NCRT后ADC与△ADC%高于非pCR组,奥沙利铂治疗占比与NCRT前ADC低于非pCR组(P<0.05)。多因素Logistic回归分析结果显示:NCRT前ADC、NCRT后ADC及△ADC%为LARC患者NCRT后pCR的独立影响因素(P<0.05)。ROC曲线分析显示:NCRT前ADC、NCRT后ADC、△ADC%联合预测LARC患者NCRT后pCR的AUC高于单一指标的AUC(P<0.05)。结论:NCRT前ADC、NCRT后ADC及△ADC%为LARC患者NCRT后pCR的独立影响因素。其中NCRT前ADC、NCRT后ADC、△ADC%可作为LARC患者NCRT后pCR的预测因素,且三组参数联合预测价值更为理想。Objective:To explore the predictive efficacy of magnetic resonance imaging(MRI) on pathological complete response(pCR) after preoperative neo-adjuvant chemoradiotherapy(NCRT) in patients with locally advanced rectal cancer(LARC).Methods:Ninety-two patients with LARC who were treated in the gastrointestinal surgery department of one "AAA" Hospital in Xi'an,Shaanxi Province from November 2019 to October 2023 were retrospectively included,and were divided into pCR group(n=21) and non-PCR group(n=71) according to the pathological results after NCRT.All patients underwent routine MR examination and diffusion-weighted imaging(DWI) before and after NCRT,and their clinical and imaging features were collected.Univariate and multivariate Logistic regression analysis was used to determine the related influencing factors of pCR.The receiver operating characteristic(ROC) curve was drawn based on multi-factor Logistic regression analysis.The area under curve(AUC) was used to analyze the predictive value of imaging features for pCR.Results:The results of single factor analysis showed that the ADC and △ADC% after NCRT in pCR group was higher than that in non-PCR group,and the proportion of oxaliplatin treatment and ADC before NCRT were lower than that in non-PCR group(P<0.05).Multivariate Logistic regression analysis showed that pre-NCRT ADC,post-NCRT ADC and △ADC% were independent influencing factors of post-NCRT pCR in LARC patients(P<0.05).ROC curve analysis showed that pre-NCRT ADC,post-NCRT ADC and △ADC% combined predicted that the AUC of post-NCRT pCR in LARC patients was higher than that of a single index(P<0.05).Conclusion:Pre-NCRT ADC,post-NCRT ADC and △ADC% are independent factors of post-NCRT pCR in LARC patients.Among them,pre-NCRT ADC,post-NCRT ADC,△ADC% can be used as predictive factors of post-NCRT pCR in LARC patients,and the combined prediction value of the three groups of parameters is more ideal.

关 键 词：磁共振弥散加权成像 局部进展期直肠癌 新辅助放化疗 病理完全反应 多因素LOGISTIC回归分析 

分 类 号：R735.37[医药卫生—肿瘤]