化疗后QCT体质指标对于急性髓系白血病生存预后影响的初步研究  

Preliminarystudy of the Impaction of QCTmetrics On the Survival Outcome Evaluationin AML Patients after Chemotherapy

作　　者：张雅欣 全冠民[1] 袁涛[1] ZHANG Yaxin;QUAN Guanmin;YUAN Tao(Department of Medical Imaging,The Second Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050000,P.R.China)

机构地区：[1]河北医科大学第二医院影像科,050000

出　　处：《临床放射学杂志》2024年第10期1805-1811,共7页Journal of Clinical Radiology

摘　　要：目的探讨化疗后定量CT(QCT)体质指标变化对急性髓系白血病(AML)生存预后预测的价值。方法回顾性分析114例化疗前后AML患者临床特征及QCT体质成分指标变化。以中位总生存时间(OS)区分预后良好与预后不良。比较AML预后良好组与预后不良组临床和影像体质指标的差异。多因素Cox分析确定与AML预后相关的独立危险因素。采用受试者工作特征曲线(ROC)评估临床模型、影像体质模型及综合模型对于AML患者生存预后的预测效能。结果与预后良好组相比,预后不良组年龄较大(P=0.022)、风险分层较高(P=0.002)、微小残留病灶(MRD)趋向阳性(P=0.017);预后不良组AML患者肌肉减少>3.97%(P=0.001)、皮下脂肪(SAT)减少>6.53%(P<0.001)及体腔脂肪(VAT)减少>5.35%(P=0.014)发生率较高。多因素分析显示,年龄较大(P=0.025)、风险分层较高(P=0.003)、MRD阳性(P=0.001)、化疗后肌肉减少>3.97%(P=0.044)、SAT减少>6.53%(P<0.001)、VAT减少>5.35%(P=0.035)是AML患者不良OS的独立危险因素。临床、影像体质因素及综合模型预测AML不良OS的曲线下面积(AUC)值分别为0.786、0.697、0.810,Delong检验显示影像体质模型的AUC与综合模型的AUC差异具有统计学意义(P=0.026)。临床、影像体质因素及综合模型预测AML无病生存期(DFS)的AUC值分别为0.763、0.664、0.785,Delong检验显示影像体质模型的AUC与综合模型的AUC差异具有统计学意义(P=0.041)。结论AML患者化疗后QCT体质检测具有可行性,其肌肉和脂肪指标均下降。这些指标联合临床因素可提高其对AML患者的生存预后评估效能,提示应在AML化疗后常规进行QCT体质分析。Objective Patients with acute myeloid leukemia(AML)may experience physicalcomposition changes as a result of chemotherapy.However,it is unclear if these physical composition changes will affect the survival outcome or not.This study aims to assess the predictive value of abnormal quantitative CT(QCT)bodycompositionmetricsafter chemotherapy onpredicting survival outcomes in AML patients.Methods The clinical factors and evolution of QCT metrics of 114 AML patients pre-and post-chemotherapy were analyzed retrospectively.Based on the median overall survival(OS),these AML patients were assigned into favorable and poor outcome groups.We compared the clinical factors and QCT metrics between the two groups.Multivariate Cox analysis was used to identify the independent risk factors which associated with the poor outcome.Receiver operating characteristic curve(ROC)was employed to evaluate the diagnostic performances of the clinical,QCT,and combination models in assessing poor survival outcome of AML patients.Results Compared to patients with favorable survival outcome,the patients with poor outcome were elder(P=0.022),higher risk stratification(P=0.002),more positive minimal residual lesion(MRD)(P=0.017),higher incidence of sarcopenia(P=0.001),higher incidence of decrease of subcutaneous adipose(SAT)(P=0.001)and visceral adipose(VAT)(P=0.014).Multivariate analysis showed that elder(P=0.025),higher risk stratification(P=0.003),positive MRD(P=0.001),sarcopenia(P=0.044),decrease of SAT(P<0.001)and VAT(P=0.035)were the independent risk factors of poor OS.The AUC values(AUCs)of clinical,imaging,and combination models in predicting poor OS of AML patients were 0.786,0.697,and 0.810,respectively.Delong test showed that there was significant difference among the AUCs of these models(P=0.026)in predicting poor OS.The AUCs of clinical,imaging,and combination models in predicting disease-free survival(DFS)were 0.763,0.664,and 0.785,respectively.However,there was only significant difference of AUCs between imaging and combination mode

关 键 词：急性髓系白血病 预后 化疗 体质 定量CT 

分 类 号：R733.71[医药卫生—肿瘤]