CT影像学及临床病理学特征在预测结肠癌肿瘤沉积中的价值

The Value of Enhancement CT and Clinicopathologic Characteristics for Predicting Colon Cancer Tumor Deposits

目的研究CT影像学及疗前临床病理学特征在预测结肠癌肿瘤沉积(TDs)中的价值。方法回顾性分析在我院行结肠癌根治术的83例结肠癌患者的临床病理及影像学特征,分析其预测TDs的价值。影像学特征包括疗前肿瘤T分期、静脉期肿瘤强化均匀性、轴位动静脉期肿瘤最大层面CT值及其与腰大肌比值、淋巴结强化及边缘、淋巴结长短径及比值;临床特征包括疗前CA19-9、癌胚抗原(CEA),患者性别、年龄,是否合并肠梗阻、腹腔积液;病理学特征包括肿瘤病理类型、病理学淋巴结良恶性。采用SPSS软件对所有的单因素变量进行Logistic回归分析,将P<0.1的单因素变量纳入多因素Logistic回归分析,利用受试者工作特征曲线(ROC)评估变量预测效能。结果疗前CEA、性别、静脉期肿瘤强化均匀性、腹腔积液、病理学淋巴结良恶性、影像T分期、淋巴结长径7个P<0.1单因素变量纳入多因素Logistic分析。多因素分析结果表明,男性相对于女性预测TDs的OR值为0.160(95%CI:0.035~0.742,P=0.019),差异具有统计学意义;病理学淋巴结阴性相对于阳性预测TDs的OR值为0.242(95%CI:0.056~1.042,P=0.057),具有交界性统计学意义;疗前CEA、静脉期肿瘤均匀强化、无腹腔积液、T2期病变、淋巴结长径预测肿瘤沉积的OR值为0.305~1.815,P值为0.196~0.438,差异无统计学意义。ROC分析性别、病理学淋巴结预测肿瘤沉积的AUC分别为0.613、0.760。结论女性患者、肿瘤强化不均匀、T分期较晚患者出现TDs的风险更高。病理学检查中pN阳性结肠癌患者需仔细评估其有无TDs。

Objective The aim of this study was to investigate the predicting value of enhancement CT characteristics and baseline clinicopathological features in colon cancer tumor deposits(TDs).Methods Between 2014 to 2015,83 colon cancer patients were included in this retrospective study.Colon cancer characteristics of enhancement CT include imaging T staging,homogenous/heterogenous enhancement,CT attenuation values in arterial/venous phase and ratio,lymph node border and enhancement,lymph node long/short axes and ratio.The clinical biomarkers included baseline serum CA19-9 and CEA level,age,gender,whether there was intestinal obstruction or ascites.Pathological features included tumor pathological type and pN negativity/positivity.SPSS statistic software was used for univariate Logistic regression analysis.P<0.1 univariables were analysed by multivariable Logistic regression.ROC curve(AUC,SE,SP and accuracy)were used for indicating the performance.Results Baseline serum CEA level,gender,pN stage,tumor enhancement,ascites,T staging and lymph node long axes were included in multivariate analysis(P<0.1).Multivariate analysis showed that,male patients were detected TDs with OR 0.160(95%CI 0.035-0.742,P=0.019)compared to females,with statistical significance.The OR values were borderline significant in pN negativity and pN positivity patients for TDs(OR=0.242,95%CI 0.056-1.042,P=0.057).Baseline serum CEA level,tumor homogenous enhancement,absence of ascites,T2 stage and lymph node long axes showed no significant difference,with the OR value ranging from 0.305 to 1.815(P=0.196-0.438).The AUC under gender and pN stage for predicting TDs were 0.613 and 0.760,respectively.Conclusion Female patients,patients with uneven tumor enhancement,and patients with a late T stage are at higher risk of tumor deposition.Patients with pN-positive colon cancer during pathological examination should be carefully evaluated for TDs.