MRI在直肠癌术前T分期中的影响因素研究

Study on factors influencing the value of MRI in the preoperative T staging of rectal cancer

目的探讨MRI检查在直肠癌术前T分期中的准确性及其影响因素。方法收集该科室近年来收治的直肠癌患者临床资料,通过与术后病理检查结果进行比较,确定术前MRI对T分期诊断的准确率,并比较按照不同临床参数进行分组时T分期准确率的差异。结果 MRI对直肠癌术前T分期的准确率为60.91%。单因素分析显示在患者性别、年龄,肿瘤分化程度、大体类型、距肛缘距离、浸润肠壁的部位不同的情况下MRI对T分期的准确率差异无统计学意义,但对直径大于4 cm、T3-4期肿瘤诊断的准确率显著高于直径4 cm及以下、T1-2期的肿瘤。经多因素分析显示,仅有病理分期对MRI在直肠癌术前T分期中的准确率有显著影响。结论 MRI检查用于直肠癌术前T分期有较高的应用价值,有助于确定患者是否需要进行新辅助治疗,其应用不受患者性别、年龄,肿瘤分化程度、大体类型、距肛缘距离、浸润肠壁部位及大小的影响。

Objective To explore the accuracy of MRI in the preoperative T staging of rectal cancer and its possible influencing factors. Methods The clinical data of patients with rectal cancer who had received operations in our division in recent years were collected and analyzed. Preoperative T staging assessed by MRI was compared with the pathologic diagnosis after operation to gain the accuracy. Further, the patients were divided into subgroups by different clinical parameters and the accuracy of the subgroups was compared with each other to find out which clinical parameter was related to the diagnostic accuracy of MRI. Results MRI had a total accuracy of 60.91% in all patients. The results of single factor analysis showed, the sex, age, cell differentiation, the macroscopic appearance, the distance from the anal verge, or the main infiltrating position of the tumor had no significant influence on the diagnostic accuracy of MRI, but the diagnostic accuracy in subgroup which tumor had a diameter 〉 4 centimeters or had a pathological diagnosis of T3 - 4 was higher than that of ≤4 centimeters or T1 - 2. The result of multiplicity showed that only pathological diagnosis had significant influence on the diagnostic accuracy of MRI. Conclusions MRI has a good value in the preoperative T staging of rectal cancer and is useful to decide whether the patients should be treated with neoadjuvant chemoradiotherapy. This value is not influenced by the sex, age, cell differentiation, macroscopic appearance, distance from the anal verge, main infiltrating position, or the size of the tumor.