多层螺旋CT联合纤维蛋白原或血清淀粉样蛋白A对直肠癌外科决策的随机对照研究

Randomized Controlled Trial of Combining Multi-Slice Spiral Computer Tomography with Serum Amyloid A Protein or Fibrinogen on Rectal Cancer Surgical Decision Making

目的探讨多学科协作模式（MDT）下血清淀粉样蛋白A（SAA）或纤维蛋白原（FIB）和64排多层螺旋CT（MSCT）联合评估对于直肠癌手术方式选择的影响和意义。方法前瞻性纳入2009年2～6月期间四川大学华西医院肛肠外科住院的直肠癌患者240例，随机均分为MSCT＋SAA组（术前行MSCT和SAA联合评估）和MSCT＋FIB组（术前行MSCT和FIB联合评估），将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较，并分析手术方案选择与临床病理因素的关系。结果本研究实际纳入病例234例，MSCT＋SAA组118例，MSCT＋FIB组116例，2组基线情况一致（P〉0．05）。MSCT＋SAA组的术前T、N、M和TNM分期的准确度分别为72．9％、83．1％、100％和80．1％；MSCT＋FIB组的术前T、N、M和TNM分期的准确度分别为68．1％、75．0％、100％和74．1％。2组术前各分期准确度差异均无统计学意义（P〉0．05）。2组手术方案的预测符合率分别为99．6％及96．6％，差异无统计学意义（P〉0．05）。分析直肠癌手术方案的选择与多种临床病理因素的关系发现，pT分期（P〈0．001）、pN分期（P〈0．001）、pTNM分期（P〈0．001）、术前血清SAA水平（P〈0．001）、术前血清FIB水平（P〈0．001）和肿瘤下缘距齿状线距离（P〈0．05）与直肠癌手术方案的选择相关。结论MSCT联合FIB可以提高直肠癌术前分期和手术方案预测的准确度，但其临床价值可能并不优于MSCT联合SAA。

Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computer tomography （MSCT） with serum amyloid A protein （SAA） or fibrinogen （FIB） on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled 240 patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to June 2009 were randomly assigned into two groups. In one group named MSCT＋SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT＋ FIB group, both MSCT and FIB combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results According to the criteria, 234 patients were actually included into MSCT＋SAA group （n= 118） and MSCT＋FIB group （n= 116）. The baseline characteristics of two groups were statistically similar （P〉 0.05）. For MSCT＋SAA group, the accuracies of preoperative staging T, N, M and TNM were 72.9%, 83.1% ,100% and 80.1%, respectively. For MSCT＋FIB group, the accuracies of preoperative staging T, N, M and TNM were 68.1%, 75.0%, 100% and 74.1%, respectively, and there was not a statistically significant difference （P〉 0.05）. There was also not a statistically significant difference of the accuracy of prediction to operative procedures in two groups （99.6% vs. 96.6%, P〉0.05）. The preoperative T staging （P〈0. 001）, N staging （P〈0. 001）, TNM staging （P〈0. 001）, serum level of SAA （P〈0. 001）, serum level of FIB （P〈0. 001） and distance of tumor to the dentate line （P〈0.05） were associated to the operative procedures. Conclusions Combinative assessment of MSCT and FIB could improve the accuracy of preoperative staging and operative procedures prediction, however, it may be not superior to MSCT plus SAA.