基于术前对比增强CT和临床病理特征的结直肠癌错配修复缺陷预测模型构建  

Construction of a prediction model for mismatch repair defects in colorectal cancer based on preoperative contrast-enhanced CT and clinicopathologic features

作　　者：袁硕 张斌[1] 安志强 张凯[1] 郑程阳 魏衍泽 YUAN Shuo;ZHANG Bin;AN Zhiqiang;ZHANG Kai;ZHANG Chengyang;WEI Yanze(Imaging Center,Puyang People's Hospital,Xinxiang Medical College,Puyang 457099,China)

机构地区：[1]新乡医学院附属濮阳市人民医院影像中心,河南濮阳457099

出　　处：《分子影像学杂志》2025年第3期330-339,共10页Journal of Molecular Imaging

基　　金：河南省医学科技攻关计划联合共建重点项目(LHGJ20240807)。

摘　　要：目的 探讨根据微卫星不稳定性(MSI-H)/错配修复缺陷(dMMR),对比术前增强CT与结直肠癌临床病理特征之间的相关性。方法 回顾性纳入2022年8月~2024年7月于新乡医学院附属濮阳市人民医院就诊的203例患者,并将其分为dMMR组(n=39)和错配修复(pMMR)组(n=164)。分析术前增强CT特征和临床病理特征,进行单因素和多因素Logistic分析,并根据多因素Logistic分析筛选相关因素构建预测模型,创建列线图,评估模型的校准图和临床适用性并进行内部验证。结果 多因素分析中,病灶位置(OR=0.37,P=0.046)、分化程度(中分化OR=0.24,P=0.009)、瘤内低亮度占比(1/3~2/3:OR=1.233,P=0.010;>2/3:OR=6.90,P=0.008)、最大淋巴结短径≥8 mm(OR=2.67,P=0.039)、肿瘤短径(OR=1.59,P=0.002)是dMMR发生的独立影响因素(P<0.05)。模型内部验证平均AUC分别为0.878(0.817~0.934)、0.824(0.737~0.877),模型区分度佳。结论 CT影像学特征与结直肠癌临床病理特征的结合与MMR状态相关,可提供无创MMR预测,构建的列线图预测模型具有良好的诊断性能。Objective To investigate the correlation between preoperative enhanced CT and clinicopathologic features of colorectal cancer according to microsatellite instability(MSI-H)/mismatch repair defects(dMMR).Methods A total of 203 patients who attended Puyang People's Hospital affiliated with Xinxiang Medical College from August 2022 to July 2024 were retrospectively collected and included,and they were divided into the dMMR group(n=39)and the mismatch repair(pMMR)group(n=164).Preoperative enhanced CT features and clinicopathological features were analyzed,one-way and multifactorial Logistic analysis was performed,and the predictive model was constructed by screening relevant factors based on multifactorial Logistic analysis,creating column-line diagrams,evaluating the calibration chart and clinical applicability of the model and performing internal validation.Results In multifactorial analysis,lesion location(OR=0.37,P=0.046),degree of differentiation(moderately differentiated OR=0.24,P=0.009),percentage of intratumoral hypoluminescence(1/3-2/3:OR=1.233,P=0.010;>2/3:OR=6.90,P=0.008),short diameter of the largest lymph node≥8 mm(OR=2.67,P=0.039),and tumor short diameter(OR=1.59,P=0.002)were independent influences on the occurrence of dMMR(P<0.05).The mean AUC of internal validation of the model was 0.878(0.817-0.934)and 0.824(0.737-0.877),respectively,with good model differentiation.Conclusion The combination of CT imaging features and clinicopathologic features of colorectal cancer correlates with MMR status,which provides noninvasive MMR prediction,and the construction of a column-line graph prediction model shows good diagnostic performance.

关 键 词：结直肠癌 微卫星不稳定 错配修复蛋白 免疫组化 

分 类 号：R73[医药卫生—肿瘤]