白蛋白-胆红素评分联合基线直肠MRI预测直肠癌肝转移放疗远隔效应价值探讨  

Exploration of the value of albumin-bilirubin score combined with baseline rectal MRI in predicting the distant effect of radiotherapy for liver metastasis of rectal cancer

作　　者：阙开乾 罗惠煌 谢炳开 李泉兴 汤琅琅 QUE Kaiqian;LUO Huihuang;XIE Bingkai;LI Quanxing;TANG Langlang(Radiochemotherapy Department,Longyan First Affiliated Hospital of Fujian Medical University,Fujian,Longyan 364000,China;Enterochirurgia Department,Longyan First Affiliated Hospital of Fujian Medical University,Fujian,Longyan 364000,China;Radiology Department,Longyan First Affiliated Hospital of Fujian Medical University,Fujian,Longyan 364000,China)

机构地区：[1]福建医科大学附属龙岩第一医院放化疗科,福建龙岩364000 [2]福建医科大学附属龙岩第一医院胃肠外科,福建龙岩364000 [3]福建医科大学附属龙岩第一医院放射科,福建龙岩364000

出　　处：《中国医药科学》2024年第20期139-143,172,共6页China Medicine And Pharmacy

基　　金：福建省龙岩市科技计划联合资金项目(2020LYF17038)。

摘　　要：目的 基于白蛋白-胆红素评分(ALBI)联合基线直肠MRI探讨直肠癌肝转移放疗后肝转移灶生存预后危险因素。方法 搜集2014年12月至2021年12月福建医科大学附属龙岩第一医院晚期直肠癌并行放疗或放化疗且符合条件病例29例,实验室检查及直肠MRI均为治疗前基线数据,评估终点为无进展生存(PFS)期,采用SPSS软件评估基线资料及Cox回归分析。结果 患者中位随访时长为26个月,肝转移灶进展组19例(65.52%),无进展组10例(34.48%),两组在直肠癌放疗后肿瘤病理退缩分级(RCRG)分级的差异有统计学意义(P=0.012)。壁外静脉血管侵犯(EMVI)阴性组较阳性组的PFS期长(P=0.006),直肠癌放疗后RCRG分级,级别越高PFS期越短(P=0.017)。单因素Cox回归分析中直肠癌基线长径、EMVI是治疗反应的独立因素(P=0.027、0.006);基于ALBI评分构建多因素临床模型,ALBI评分、直肠癌基线长径、EMVI、直肠癌基线T分期差异均有统计学意义(P <0.05),模型的受试者工作特征曲线(ROC)的曲线下面积(AUC)为0.841(P <0.001,95%CI:0.650~0.952)。结论 ALBI联合基线直肠MRI的长径、EMVI、T分期对直肠癌肝转移灶的预后具有预测价值,值得在今后研究中作进一步探讨。Objective To explore the prognostic risk factors for survival of liver metastases in rectal cancer after radiotherapy based on the albumin-bilirubin(ALBI)grade combined with baseline rectal MRI.Methods A total of 29 eligible patients with advanced rectal cancer who underwent concurrent radiotherapy or chemotherapy at Longyan First Affiliated Hospital of Fujian Medical University from December 2014 to December 2021 were collected.Laboratory tests and rectal MRI were used as baseline data before treatment,and the evaluation endpoint was progression free survival(PFS).SPSS software was used to evaluate the baseline data and Cox regression analysis.Results The median follow-up time of patients was 26 months.There were 19 cases(65.52%)in the liver metastasis progression group and 10 cases(34.48%)in the non-progression group.There was significant difference in rectal cancer regression grade(RCRG)between the two groups after radiotherapy for rectal cancer(P=0.012).The progression-free survival time in the negative group of extramural venous invasion(EMVI)was longer than that in the positive group(P=0.006).The higher the RCRG grading of rectal cancer after radiotherapy,the shorter the progression-free survival time(P=0.017).In univariate Cox regression analysis,the baseline length and EMVI of rectal cancer were independent factors of treatment response(P=0.027,0.006).A multi-factor clinical model was constructed based on ALBI score.The ALBI score,the baseline length of rectal cancer,EMVI and the baseline T stage of rectal cancer were statistically significant(P<0.05).The area under the curve(AUC)of receiver operating characteristic curve(ROC)of the model was 0.841(P<0.001,95%CI:0.650-0.952).Conclusion ALBI combined with baseline rectal MRI length,EMVI and T staging has predictive value for the prognosis of liver metastasis of rectal cancer,which is worth further discussion in future research.

关 键 词：直肠肿瘤 MRI 放射治疗 肝转移 

分 类 号：R735.37[医药卫生—肿瘤]