基于CT机体成分指标预测Ⅱ~Ⅲ期结直肠癌患者术后预后的价值  

Prognostic value of CT-based body composition indicators in predicting postoperative outcomes of patients with stageⅡ-Ⅲcolorectal cancer

作　　者：柴瑾[1] 刘念军 白俊芳 郭顺林[2] CHAI Jing;LIU Nian-jun;BAI Jun-fang;GUO Shun-lin(Health Examination Center,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu,CHINA;Department of Radiology,the First Hospital of Lanzhou University,Lanzhou 730000,Gansu,CHINA)

机构地区：[1]兰州大学第一医院健康体检中心,甘肃兰州730000 [2]兰州大学第一医院放射科,甘肃兰州730000

出　　处：《海南医学》2025年第6期831-836,共6页Hainan Medical Journal

基　　金：甘肃省自然科学基金(编号:25JRRA556)。

摘　　要：目的基于腹部非对比增强CT(NCECT)获得的机体骨骼肌、内脏脂肪组织、皮下脂肪组织预测Ⅱ~Ⅲ期结直肠癌(CRC)患者的预后。方法回顾性分析2018年6月至2021年12月期间经兰州大学第一医院手术病理证实的113例Ⅱ~Ⅲ期CRC患者的术前NCECT图像和基线临床信息,包括年龄、性别、基因突变信息、肿瘤标志物(CEA、CA199)等;通过自动分割软件定位术前腰3锥体(L3)层面的轴位CT图像,使用阈值调节法[骨骼肌为(-29,150)HU,皮下脂肪组织和肌间脂肪组织为(-190,-30)HU,内脏脂肪组织为(-150,-50)HU]半自动分割并测量骨骼肌面积(SMA)、内脏脂肪组织(VAT)和皮下脂肪组织(SAT)。计算获取骨骼肌指数(SMI)=SMA(cm^(2))/身高2(m^(2))。采用Cox逻辑回归方法分析机体成分指标(SMA、VAT、SAT)与术后无进展生存期(PFS)和总生存期(OS)的关系,使用Kaplan-Meier(K-M)方法获取最佳截断值以分层不良预后状态。结果不同性别的L3-SMA(男:女=110.39:106.98 cm^(2))比较差异有统计学意义(P<0.05)。Cox逻辑回归分析结果显示,K-RAS基因突变、SMA、骨骼肌指数(SMI)均是CRC患者术后PFS和OS的危险因素(P<0.05),其中SMI是CRC患者术后OS(HR:0.626,95%CI:0.402~0.974,P=0.038)的重要风险因子。K-M生存曲线显示L3-SMA和SMI分别以110.42 cm^(2)、38.02 cm^(2)/m^(2)为截止值时可以分层CRC患者的远期不良预后状态(P<0.01)。结论基于术前腹部NCECT的L3-SMA和SMI可以早期分层Ⅱ~Ⅲ期CRC术后的预后状态。Objective To evaluate the prognostic value of skeletal muscle,visceral adipose tissue(VAT),and subcutaneous adipose tissue(SAT)measured by preoperative non-contrast-enhanced CT(NCECT)in predicting outcomes of patients with stageⅡ-Ⅲcolorectal cancer(CRC)after surgery.Methods Preoperative NCECT images and clinical data(age,sex,genetic mutations,tumor markers[CEA,CA199])of 113 patients with stageⅡ-ⅢCRC confirmed by surgical pathology at the First Hospital of Lanzhou University from June 2018 to December 2021 were retro spectively analyzed.Axial CT images at the third lumbar vertebra(L3)level were segmented using automated software with threshold-based methods:skeletal muscle,(-29,150)HU;SAT and intermuscular adipose tissue,(-190,-30)HU;and VAT(-150,-50)HU.Skeletal muscle area(SMA),VAT,and SAT were quantified.Skeletal muscle index(SMI)was calculated as SMA(cm^(2))/height2(m^(2)).Cox regression analysis and Kaplan-Meier(K-M)survival curves were used to assess associations between body composition indicators(SMA,VAT,SAT)and postoperative progression-free survival(PFS)and overall survival(OS).Results L3-SMA differed significantly between genders(male:110.39 cm^(2)vs female:106.98 cm^(2),P<0.05).Cox analysis identified KRAS mutation,SMA,and SMI as independent risk factors for PFS and OS(P<0.05),with SMI being a critical predictor of OS(HR:0.626,95%CI:0.402-0.974,P=0.038).K-M curves stratified poor prognosis using cutoff values of L3-SMA(110.42 cm^(2))and SMI(38.02 cm^(2)/m^(2)),P<0.01.Conclusion Preoperative NCECT-derived L3-SMA and SMI effectively stratify postoperative prognosis in patients with stageⅡ-Ⅲcolorectal cancer.

关 键 词：结直肠癌 体层摄影术 预后 机体成分 

分 类 号：R735[医药卫生—肿瘤]