多层螺旋CT联合血清淀粉样蛋白A术前评估直肠癌在外科决策中的价值

Value of combining 64 multi-slice spiral computer tomography and serum amyloid A protein in surgical decision-making in rectal cancer

目的探讨64排多层螺旋CT（MSCT）和血清淀粉样蛋白A（SAA）联合术前评估进行直肠癌术前分期的准确性及其临床应用价值。方法前瞻性纳入2007年10月至2008年10月期间住院的225例直肠癌患者，将患者随机分为MSCT组和MSCT与SAA联合组，联合组术前行MSCT和SAA联合评估，MSCT组术前只行MSCT评估。分别将两组术前T、N、M、TNM分期准确度进行比较，并比较两组手术方案的预测符合率。结果本研究实际纳入病例225例，MSCT和SAA联合组110例，MSCT组115例，两组基线情况具有可比性。联合组术前T、N、M和TNM分期的准确度分别为87．3％、85．2％、100％和86．4％，MSCT组的准确度分别为85．2％、67．0％、100％和66．1％；两组术前N分期和TNM分期准确度差异具有统计学意义（P=0．009、0．001）。两组手术方案的预测符合率分别为94．7％和81．7％，差异具有统计学意义（P=0．003）。结论MSCT和SAA联合评估的策略可以提高直肠癌患者术前分期N、TNM的准确性，并可提高预测手术方案的符合率。

Objective To determine the accuracy and clinical value of combining 64 multi-slice spiral computer tomography （MSCT） and serum amyloid A protein （ SAA ） in the preoperative staging of rectal cancer. Methods Prospectively enrolled patients with rectal cancer from October 2007 to October 2008. The patients were randomly assigned into two groups： MSCT and SAA combined group： both MSCT and SAA combinative assessment were performed for preoperative evaluation; MSCT group： only MSCT was performed preoperatively for tumor staging. The accuracy of the preoperative T, N, M, and TNM staging and the concordance rate of predictive operative strategy were compared between the two groups. Results Total of 225 cases with rectal cancer were enrolled in this study. There were 110 cases in MSCT and SAA combined group and 115 cases in MSCT group. The baseline characteristics was comparable between the two groups. For MSCT and SAA combined group, the accuracies of preoperative staging of T, N, M and TNM was 87. 3% , 85. 2% , 100% and 86.4%, respectively; and for MSCT group, the corresponding rates was 85.2% , 67.0% , 100% and 66. 1% , respectively. Statistical differences was found in the accuracy of preoperative N and TNM staging between the two groups （P = 0. 009 and 0. 001, respectively）. In addition, there was statistical difference in the accuracy of prediction to operative procedures between the two groups （94. 7% vs. 81.7% , P =0. 003）. Conclusion Combinative assessment of MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate of operative Drocedures.