动态对比增强磁共振成像药代动力学参数对宫颈癌患者同步放化疗近期疗效与预后的评估价值  

Value of pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging in assessing the short-term response and prognosis of cervical cancer patients undergoing concurrent chemoradiotherapy

作　　者：彭东 田艺 蒋士杰 徐华 何承勇 PENG Dong;TIAN Yi;JIANG Shijie;XU Hua;HE Chengyong(Xi′an People’s Hospital(Xi′an Fourth Hospital),Xi′an 710004,China)

机构地区：[1]西安市人民医院(西安市第四医院),陕西西安710004

出　　处：《精准医学杂志》2025年第1期51-54,59,共5页Journal of Precision Medicine

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)药代动力学参数对宫颈癌患者同步放化疗近期疗效与预后的评估价值。方法选取本院2020年10月—2022年3月接受同步放化疗的120例宫颈癌患者为研究对象,依据治疗结果分为有效组和无效组,依据随访结果分为不良结局组和非不良结局组,对有效组和无效组、不良结局组和非不良结局组患者治疗结束时DCE-MRI药代动力学参数[容积转移常数(K^(trans))、组织间隙-血浆速率常数(K_(ep))、细胞外间隙容积分数(V_(e))]进行比较;采用受试者工作特征(ROC)曲线分析治疗后DCE-MRI药代动力学参数对宫颈癌患者不良结局的评估价值;采用logistic回归分析影响宫颈癌患者不良结局的相关因素。结果无效组与有效组患者V_(e)治疗前后差值比较有显著差异(t=3.817,P<0.05),K^(trans)、K_(ep)治疗前后差值比较无显著差异(P>0.05)。不良结局组与非不良结局组患者K^(trans)、V_(e)治疗前后差值有显著差异(t=3.344、6.230,P<0.05),K_(ep)治疗前后差值比较无显著差异(P>0.05)。ROC曲线分析显示,治疗结束时,K^(trans)、V_(e)预测宫颈癌患者不良结局的曲线下面积(AUC)分别为0.783、0.743(P<0.05)。不良结局组与非不良结局组患者的FIGO分期、分化程度比较差异有显著性(χ^(2)=11.749、6.073,P<0.05),logistic回归分析结果显示,K^(trans)与V_(e)值较低、FIGO分期Ⅳ期、分化程度低是宫颈癌患者不良结局的独立危险因素(OR=0.022~1.896,P<0.05)。结论DCE-MRI药代动力学参数与宫颈癌患者同步放化疗预后关系密切,治疗后K^(trans)和V_(e)值升高提示肿瘤消退程度较好,可作为近期疗效评估的重要指标;治疗后K^(trans)和V_(e)值降低则与宫颈癌预后风险增加有关,对患者预后有重要预测价值。Objective To investigate the value of pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in assessing the short-term response and prognosis of cervical cancer patients undergoing concurrent chemoradiotherapy.Methods A total of 120 cervical cancer patients who underwent concurrent chemoradiotherapy in our hospital from October 2020 to March 2022 were enrolled as subjects,and according to the treatment outcome,they were divi-ded into response group and non-response group,while according to the follow-up results,they were divided into adverse outcome group and non-adverse outcome group.The pharmacokinetic parameters derived from DCE-MRI[volume transfer constant(K^(trans)),interstitium-to-plasma rate constant(K_(ep)),and extracellular volume fraction(V_(e))]were compared between the response group and the non-response group and between the adverse outcome group and the non-adverse outcome group.The receiver opera-ting characteristic(ROC)curve was used to analyze the value of pharmacokinetic parameters derived from DCE-MRI in assessing the adverse outcomes of cervical cancer patients after treatment,and a logistic regression analysis was used to investigate the in-fluencing factors for the adverse outcomes of cervical cancer patients.Results There was a significant difference in the change in V_(e) after treatment between the response group and the non-response group(t=3.817,P<0.05),while there were no significant differences in the changes in K^(trans) and K_(ep) between the two groups(P>0.05).There were significant differences in the changes in K^(trans) and V_(e) after treatment between the adverse outcome group and the non-adverse outcome group(t=2.675,3.636,P<0.05),while there was no significant difference in the change in K_(ep) between the two groups(P>0.05).The ROC analysis showed that at the end of treatment,K^(trans) and V_(e) had an area under the ROC curve of 0.783 and 0.743,respectively,in predicting the adverse outcomes of cervical cancer patients(P<0.05)

关 键 词：宫颈肿瘤 放化疗 多参数磁共振成像 图像增强 药代动力学 预后 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]