基于CT的细胞外容积联合病理预测胃间质瘤术后早期复发  

Combined CT-based extracellular volume with pathologic indicators predicts early postoperative recurrence of gastric mesenchymal tumors

作　　者：卢红 黎海涛 蔡萍 杜新月 尹晓勤 蒋桂伸 柴华凤 韦雪 邓亚利 邓国兰[1] LU Hong;LI Haitao;CAI Ping;DU Xinyue;YIN Xiaoqin;JIANG Guishen;CHAI Huafeng;WEI Xue;DENG Yali;DENG Guolan(Department of Cardiovascular Diseases,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Radiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016 [2]陆军军医大学(第三军医大学)第一附属医院放射科,重庆400038

出　　处：《陆军军医大学学报》2024年第23期2661-2669,共9页Journal of Army Medical University

摘　　要：目的探讨基于CT延迟期的细胞外容积(extracellular volume,ECV)联合病理预测胃间质瘤外科术后早期复发的临床价值。方法采用病例对照研究的方法,收集2011年1月至2022年8月于陆军军医大学第一附属医院手术切除的110例胃间质瘤患者的影像、临床及病理资料;男性60例,女性50例;年龄(58±10)岁。患者术前均行腹部多期动态CT增强检查,并根据公式计算ECV值:ECV=(1-血细胞比容)×(ΔHU肿瘤/ΔHU主动脉)。根据术后复发情况分为早期复发组和无早期复发组。统计指标:①一致性分析。②胃间质瘤切除术后早期复发的影响因素分析及预测模型构建,Delong检验评估模型的预测价值,基于联合模型绘制可视化列线图,使用校准曲线评估列线图效能,决策曲线分析(decision curve analysis,DCA)评估模型临床应用价值。结果①一致性分析。2名放射科医师勾画感兴趣区,并根据公式计算获得ECV值,组内相关系数(intraclass correlation coefficients,ICC)为0.806。②胃间质瘤术后早期复发的影响因素分析及预测模型构建。110例患者,早期复发21例,无早期复发89例。多因素分析结果表明:ECV值、肿瘤长径、危险度是预测早期复发的独立影响因素。以ECV、肿瘤长径、危险度为独立预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算受试者工作特征曲线下面积(area under cyrve,AUC)分别为0.838(95%CI为0.758~0.918)、0.774(95%CI为0.656~0.892)、0.700(95%CI为0.589~0.810),以上述指标建立联合预测模型,并绘制可视化列线图、ROC曲线,其AUC为0.899(95%CI为0.811~0.987),高于各独立模型,其灵敏度、特异度分别为85.71%、86.52%,最佳截断值为0.19,采用Delong检验评估混合模型与危险度建立的临床模型的AUC值差异有统计学差异(Z=6.548,P<0.001,95%CI为0.140~0.259)。校准曲线提示联合模型拟合度较好,DCA曲线提示联合模型具有较好的净收益。结论ECV�Objective To investigate the clinical value of extracellular volume(ECV)based on CT delayed phase in combination with pathologic indicators in predicting early recurrence of gastric mesenchymal tumors after surgery.Methods A retrospective casecontrol trial was conducted on the imaging,clinical and pathological data of 110 patients with gastric mesenchymal tumors who were surgically resected at the First Affiliated Hospital of Army Medical University from January 2011 to August 2022.They were 60 males and 50 females,at a mean age of 58±10 years.All of them received preoperative multiphase dynamic CT enhancement examination of the abdomen,and ECV value was calculated with the formula:ECV=(1-hematocrit)×(ΔHU tumor/ΔHU aorta).According to the postoperative recurrence within 24 months after surgery,they were divided into early recurrence group and non early recurrence group.Statistical indexes:①Consistency analysis.②The factors affecting early recurrence after resection of gastric mesenchymal stromal tumors were analyzed and a prediction model was conducted.Delong test was used to assess the predictive value of the model.Then a nomogram was plotted based on the combines model,and calibration curves were drawn to assess the efficacy of the column charts,and decision curve analysis(DCA)was adopted to assess the value of the model for clinical application.Results①Consistency analysis.After 2 radiologists outlined the region of interest and obtained ECV value according to the above formula,The intraclass correlation coefficient(ICC)was 0.806.②For the 110 subjected patients,21 cases of them had early recurrence,and 89 one did not.Multivariate analysis showed that ECV value,risk degree,and tumor length were independent influencing factors for predicting early recurrence.Receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)value of ECV,hazard degree,and tumor length diameter in predicting early recurrence was 0.838(95%CI 0.758~0.918),0.774(95%CI 0.656~0.892),and 0.700(9

关 键 词：间质瘤 细胞外容积 早期复发 X线计算机体层摄影术 

分 类 号：R730.7[医药卫生—肿瘤] R735.2[医药卫生—临床医学] R814.42