术前定量CT分析身体组分对根治性切除术胰腺导管腺癌患者预后的预测价值  

Prognostic value of preoperative quantitative CT analysis of body components in patients with radical resection of pancreatic ductal adenocarcinoma

作　　者：鹿佩瑶 翟建 李云成 李培 武彤 魏逸 LU Pei-yao;ZHAI Jian;LI Yun-cheng(Department of Radiology,Yijishan Hospital of Wannan medical college,Anhui 241001,China)

机构地区：[1]皖南医学院第一附属医院弋矶山医院放射科,安徽241001

出　　处：《放射学实践》2025年第2期243-247,共5页Radiologic Practice

摘　　要：目的:探讨定量CT(QCT)术前身体组分参数对行根治性切除术的胰腺导管腺癌(PDAC)患者预后的预测价值。方法:回顾性分析接受根治性切除术的142例PDAC患者的病例资料,搜集年龄、性别、术前CA19-9、糖尿病史、腰背痛、术后有无化疗、肿瘤最大径、TNM分期、神经侵犯、淋巴结转移等信息,QCT测量身体组分参数包括L3水平的内脏脂肪面积(VFA)、皮下脂肪面积(SFA)并计算VFA/SFA比值(VSR),以及门静脉右支层面的肝脏脂肪分数(Fat%-QCT)。使用受试者工作特征(ROC)曲线获得VFA、SFA、VSR、Fat%-QCT的临界值,分别进行高、低水平分组。以Kaplan-Meier生存曲线和log-rank检验分析身体组分参数组间预后差异,采用单因素和多因素COX比例风险回归模型确定总生存期(OS)的独立风险因素。结果:VSR、Fat%-QCT高、低水平组的OS生存曲线差异有统计学意义(P<0.05)。单因素分析结果显示,VSR、Fat%-QCT、肿瘤长径≥3 cm、神经侵犯、淋巴结转移、TNM分期是OS的风险因素(P<0.05)。多因素分析结果显示,VSR、Fat%-QCT、神经侵犯、TNM分期是OS的独立危险因素(HR=1.76、1.51、2.91、1.68,P=0.006、0.039、0.008、0.012)。结论:术前VSR及肝脏脂肪含量可作为根治性切除术PDAC患者生存预后的独立风险因素,分析术前QCT身体组分参数对根治性切除术PDAC患者预后具有一定的预测价值。Objective:To explore the predictive ability of preoperative body composition parameters obtained using quantitative computed tomography(QCT)in patients with pancreatic ductal adenocarcinoma(PDAC)on their postoperative prognosis.Methods:In this study,we conducted a retrospective analysis of data from 142 patients with PDAC who underwent radical resection.We collected patient information,including age,gender,preoperative CA19-9 levels,history of diabetes,low back pain,postoperative chemotherapy,tumor maximum diameter,TNM stage,nerve invasion,and lymph node metastasis.In addition,we obtained QCT parameters including visceral fat area(VFA),subcutaneous fat area(SFA),VFA/SFA ratio(VSR)at the middle level of L3 vertebral body,and liver fat fraction at the level of the right branch of portal vein(Fat%-QCT).Using receiver operating characteristic(ROC)curves,we established cut-off values for VFA,SFA,VSR,and Fat%-QCT,and grouped patients into high and low level groups accordingly.Kaplan-Meier survival curve and log-rank tests were used to evaluate the prognostic differences of body composition parameters between these groups.We also used univariate and multivariate COX proportional hazards regression models to identify independent risk factors for overall survival(OS).Results:We observed significant differences in VSR and Fat%-QCT between the high and low level groups in OS(P<0.05).Univariate analysis indicated that VSR,Fat%-QCT,tumor length≥3cm,nerve invasion,lymph node metastasis,and TNM staging were all risk factors for OS(P<0.05).Furthermore,multivariate analysis confirmed that VSR,Fat%-QCT,nerve invasion,and TNM stage were independent risk factors for OS(HR=1.76,1.51,2.91,1.68;P=0.006,0.039,0.008,0.012).Conclusion:Our findings suggest that preoperative VSR and liver fat content can serve as independent risk factors for the survival of patients with PDAC following radical resection.Moreover,our results indicate that QCT analysis of body composition parameters prior to surgery may offer valuable predictive insights re

关 键 词：胰腺导管腺癌 胰腺肿瘤 预后 定量CT 体层摄影术 X线计算机 身体组分 根治性切除术 

分 类 号：R735.9[医药卫生—肿瘤] R814.42[医药卫生—临床医学]