CT影像组学联合胃肿瘤标志物预测晚期胃癌程序性死亡受体-1抑制剂疗效的价值  

Value of CT imaging combined with gastric tumor markers in predicting the efficacy of programmed death receptor-1 inhibitors for advanced gastric cancer

作　　者：杨萌 袁慧莹 Yang Meng;Yuan Huiying(Department of Medical Imaging,the First Affiliated Hospital of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学第一附属医院医学影像科,开封475000

出　　处：《实用医技杂志》2025年第4期255-259,共5页Journal of Practical Medical Techniques

基　　金：开封市科技发展项目(2207008)。

摘　　要：目的探讨CT影像组学联合胃肿瘤标志物预测晚期胃癌对细胞程序性死亡受体-1(PD-1)抑制剂疗效的价值。方法回顾性分析2022年9月至2024年9月就诊于河南大学第一附属医院103例接受PD-1抑制剂治疗的胃癌晚期患者的临床资料及CT影像特征,按照实体瘤疗效评定标准分为有效组(65例)和无效组(38例)。分析CT影像组学特征及胃肿瘤标志物与胃癌晚期PD-1抑制剂疗效的关系,并构建基于CT影像组学特征及胃肿瘤标志物指标的列线图预测模型;采用受试者工作特征(ROC)曲线评估预测效能,绘制校准曲线评估列线图模型的校准度。结果有效组和无效组胃癌晚期患者的肿瘤厚径[(21.3±8.5)mm和(26.5±10.5)mm,t=-2.099,P=0.038]、门静脉期与平扫CT的差值(△pp)[(47.1±12.3)Hu和(54.2±20.2)Hu,t=-2.232,P=0.008]、糖类抗原72-4(CA72-4<2.5 U/ml)(40.0%和60.5%,χ^(2)=4.051,P=0.044)、胃泌素-17(G-17<1.48) pmol/L(55.4%和26.3%,χ^(2)=8.199,P=0.004)比较差异有统计学意义。多因素结果显示,肿瘤厚径小[OR值(95%CI)=3.995(1.259,12.673),P=0.019]、△pp小[OR值(95%CI)=1.169(1.054,1.297),P=0.003]、CA72-4<2.5 U/ml[OR值(95%CI)=3.414(1.070,10.895),P=0.038]、G-17<1.48 pmol/L[OR值(95%CI)=4.121(1.327,12.793),P=0.014]均是晚期胃癌PD-1抑制剂有效的独立影响因素;基于独立影响因素构建的晚期胃癌PD-1抑制剂疗效列线图预测模型的ROC曲线下面积(AUC)为0.841,且校准曲线的平均绝对值误差为0.031。结论CT影像组学联合胃肿瘤标志物指标的综合列线图模型能较好地预测晚期胃癌PD-1抑制剂的疗效。Objective To investigate the value of CT imaging combined with gastric tumor markers in predicting the efficacy of programmed death receptor-1(PD-1)inhibitors in advanced gastric cancer.Methods Clinical data and CT image features of 103 patients with advanced gastric cancer treated with PD-1 inhibitor in the First Affiliated Hospital of Henan University from September 2022 to September 2024 were retrospectively analyzed,and they were divided into effective group(n=65)and ineffective group(n=38)according to the efficacy evaluation criteria for solid tumor.The relationship between CT imaging features and gastric tumor markers and the efficacy of PD-1 inhibitors in advanced gastric cancer was analyzed,and a nomogram prediction model based on CT imaging features and gastric tumor markers was constructed.Receiver operating characteristic(ROC)curve was used to evaluate the prediction efficiency,and calibration curve was drawn to evaluate the calibration degree of the nomogram model.Results The difference of tumor thickness diameter[(21.3±8.5)mm vs(26.5±10.5)mm,t=-2.099,P=0.038],portal vein stage(Δpp)[(47.1±12.3)Hu vs(54.2±20.2)Hu,t=-2.232,P=0.008],CA72-4(<2.5 U/ml 40.0%vs 39.5%,χ^(2)=4.051,P=0.044)and gastrin-17(G-17<1.48 pmol/L)[55.4%vs 26.3%,χ^(2)=8.199,P=0.004]between the two groups and the normal CT scan was statistically significant;The multi-factor results showed that the tumor was thick and small in diameter[OR(95%CI)=3.995(1.259,12.673),P=0.019],Δpp small[OR(95%CI)=1.169(1.054,1.297),P=0.003],CA72-4<2.5 U/ml[OR(95%CI)=3.414(1.070,10.895),P=0.038],G-17<1.48 pmol/L[OR(95%CI)=4.121(1.327,12.793),P=0.014]were independent influencing factors of effective PD-1 inhibitors in advanced gastric cancer.The area under ROC curve(AUC)of the prediction model of the efficacy of advanced gastric cancer PD-1 inhibitor based on the column graph of independent influencing factors was 0.841.The average absolute error of calibration curve is 0.031.Conclusion The comprehensive nomogram model of CT imaging combined with gastri

关 键 词：影像基因组学 生物标记 肿瘤 胃肿瘤 免疫检查点抑制剂 

分 类 号：R735.2[医药卫生—肿瘤]