扩散加权成像和循环肿瘤细胞对食管鳞癌患者放化疗短期疗效的预测价值

Values of diffusion weighted imaging and circulating tumor cells in predicting the short-term efficacy of chemoradiotherapy in patients with esophageal squamous cell carcinoma

目的:探讨磁共振扩散加权成像(DWI)和循环肿瘤细胞(CTCs)预测食管鳞癌(ESCC)患者放化疗短期疗效的价值。方法:回顾性搜集2016年11月-2018年4月经病理证实的ESCC并接受放化疗治疗的51例患者,所有患者治疗前行DWI检查和检测外周血CTCs;在DWI上测量病灶的表观扩散系数(ADC),CTCs分离采用CanPatrolTM CTC-二代富集技术,并根据上皮-间质转化(EMT)的标志物表达情况,分为上皮型、间质型、混合型3种类型;根据实体瘤的疗效评价(RECIST 1.1)标准进行短期疗效评价,完全缓解(CR)和部分缓解(PR)分为缓解组,病变进展(SD)和病变稳定(PD)分为未缓解组。比较两组各参数间的差异,采用受试者操作特征曲线(ROC)分析治疗前ESCC的ADC值及CTCs分别及联合预测疗效的诊断效能。结果:51例患者中,缓解组34例,未缓解组17例。治疗前疗缓解组ADC值[0.72(0.51~0.97)×10-3mm2/s]低于未缓解组[1.20(0.86~1.42)×10-3mm2/s],差异有统计学意义(Z=-2.857,P=0.004)。治疗前缓解组、未缓解组的间质型CTCs分别为1(0~2.25)、0(0~1),差异有统计学意义(Z=-2.333,P=0.020),而上皮型CTCs、混合型CTCs、CTCs总数在缓解组和未缓解组之间,差异无统计学意义(P=0.377、0.771、0.734)。ADC值、间质型CTCs和两者联合预测ESCC放化疗的ROC曲线下面积分别为0.747、0.689和0.825,预测放化疗疗效的敏感度分别为76.5%、70.6%和70.6%,特异度分别为79.4%、61.8%和85.3%。结论:ADC值和间质型CTCs可以作为预测ESCC放化疗短期疗效的方法,两者联合预测放化疗短期疗效诊断价值较高。

Objective:To investigate the value of diffusion weighted imaging(DWI)and circulating tumor cells(CTCs)on predicting short-term efficacy of chemoradiotherapy in patients with esophageal squamous cell carcinoma(ESCC).Methods:Fifty-one patients who were confirmed ESCC pathologically and received with chemoradiation were collected retrospectively from November 2016 to April 2018.All patients underwent DWI and CTCs examination before treatment.The apparent diffusion coefficient(ADC)value of the lesion was calculated on DWI images.CTCs were separated using CanPatrolTM CTC second generation enrichment technology and divided into three subtypes(epithelial CTCs,mesenchymal CTCs,hybrid CTCs)based on epithelial-mesenchymal transition(EMT)marker expression.Short-term efficacy evaluation was performed using the criteria of response evaluation in solid tumors(RECIST 1.1),which was divided into remission group(CR,PR)and non-remission group(SD,PD).The Mann-Whitney U test was used to compare parameters between the two groups.The predictive chemoradiotherapy responses ability of ADC value,CTCs and their combination was analyzed by receiver operating characteristic curve(ROC).Results:Thirty-four patients were in the remission group and 17 patients were in the non-remission group among the 51 patients.The remission group had lower ADC value[0.72(0.51~0.97)×10-3mm2/s]than non-remission group[1.20(0.86~1.42)×10-3mm2/s],with statistically significant difference(Z=-2.857,P=0.004).The mesenchymal CTCs in the remission group and non-remission group before treatment were 1(0~2.25)and 0(0~1),respectively,and the difference was statistically significant between the two groups(Z=-2.333,P=0.020).However,there was no statistically significant difference between the remission group and the non-remission group in the numbers of epithelial CTCs,hybrid CTCs,and total CTCs(P=0.377,0.771,0.734).The area under the ROC curve of ADC value,mesenchymal CTCs,and their combination were 0.747,0.689 and 0.825,respectively.The sensitivity of ADC value,mesenchymal CTCs,and their combination were 76.5%,70.6%and 70.6%,respectively.The specificity of ADC value,mesenchymal CTCs,and their combination were 79.4%,61.8%and 85.3%,respectively.Conclusion:ADC values and mesenchymal CTCs can be used as a method to predict short-term efficacy of chemoradiotherapy in ESCC patients,and their combination provide higher diagnostic value in predicting short-term efficacy of chemoradiotherapy.