中国实用外科杂志

中国实用外科杂志

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MRI测量原发肿瘤体积对cT3期低位直肠癌预后指导价值研究

黎    凡1，林维文2a，官国先2b，蒋伟忠2b，刘    星2b，陈致奋2b   

  1. 1厦门大学附属第一医院（厦门市肿瘤医院）胃肠肿瘤外科，福建厦门 361000；2 福建医科大学附属协和医院 a.影像科  b.结直肠外科，福建福州 350000
  • 出版日期:2019-04-01 发布日期:2019-04-04

  • Online:2019-04-01 Published:2019-04-04

摘要：

目的    探讨根据治疗前高分辨率MRI测量的原发肿瘤体积大小（PTV）对cT3期低位直肠癌进行亚分组的可行性及临床价值。方法    选取2010年6月至2012年12月福建医科大学附属协和医院结直肠外科收治的99例未接受新辅助放化疗（nCRT）且术前MRI评估为cT3期的低位直肠癌病人。运用Spearman相关分析检验PTV与肿瘤浸润超过直肠固有肌层外深度的相关性，受试者工作特征曲线（ROC）分析PTV与3年无病生存之间的关系，采用COX风险回归模型分析3年无病生存的影响因素。结果    直肠癌浸润固有肌层外最远距离与PTV呈正相关（r=0.457，P＜0.001）。99例cT3期低位直肠癌病人PTV为2.1～56.5（16.4±10.3）cm3。ROC曲线显示PTV预测3年无病生存的截点值为14.8 cm3，曲线下面积为0.829（95%CI 0.745～0.913，P＜0.001）。PPTV以截点值14.8 cm3分组，PTV>14.8 cm3组的3年无病存活率较低，局部复发率和远处转移率较高，差异有统计学意义。以截点值15.0 cm3分组结果与此相同。COX风险回归模型显示PTV是cT3期低位直肠癌病人3年无病存活率的影响因素（HR=0.180，95%CI 0.078～0.415，P＜0.05)。结论    根据治疗前高分辨率MRI测量的原发肿瘤体积大小可能有助于指导cT3期低位直肠癌预后。

关键词: 低位直肠癌, T3分期, 肿瘤体积, 预后

Abstract:

The prognostic significance of primary tumor volume by MRI in cT3 low rectal cancer        LI Fan*，LIN Wei-wen，GUAN Guo-xian，et al.  *Department of Gastrointestinal Surgery，Xiamen Cancer Hospital，the First Affiliated Hospital of Xiamen University，Xiamen 361000，China
Corresponding author：GUAN Guo-xian，E-mail: gxguan1108@163.com
Abstract    Objective    To evaluate the clinical significance of primary tumor volume (PTV) by preoperative high-resolution MRI measurement in subgroup of cT3 low rectal cancer. Methods    A total of 99 patients with low rectal cancer who confirmed by pathology and assessed at stage-cT3 by MRI，did not undergo neoadjuvant chemoradiotherapy (nCRT) treated in Department of Colorectal Surgery，Fujian Medical University Union Hospital from June 2010 to December 2012 were adopted in the study. The relations between PTV and the depths of tumor infiltration out of mesorectum were analyzed through Spearman correlation analysis. The receiver-operating characteristic (ROC) curve was used to analyze the PTV and 3-year disease-free survival. Cox proportional hazard model was performed for influence factors analysis. Results    The depth of tumor infiltration mesorectum and the PTV were revealed significantly correlated (P＜0.001，r=0.457）. The average PTV was 2.1-56.5（16.4±10.3）cm3.  ROC showed the best cutoff point of PTV 14.8 cm3，the area under the curve was 0.829 (95%CI 0.745-0.913，P＜0.001). Taking the integer 15 cm3 or 14.8 cm3，
the authors divided the patients into PTV≤ 15 cm3/> 15 cm3 or PTV≤14.8 cm3/>14.8 cm3. The difference between groups revealed significant in the 3-year disease-free survival rate，the local recurrence rate and the distant metastases rate. COX regression analysis was utilized for 3-year disease-free survival，and the multivariate analysis indicated that PTV was an independent impact factor (HR=0.180，95%CI 0.078-0.415，P＜0.05). Conclusion    The primary tumor volume (PTV) by preoperative high-resolution MRI measurement might be used as a new prognostic parameter for cT3 low rectal cancer.

Key words: low rectal cancer, T3 subgroups, tumor volume, prognosis