动态增强磁共振与HIF-1a预测食管鳞癌放化疗敏感性

Study of Dynamic Contrast-enhanced MRI and HIF-1a in Predicting the Sensitivity of Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

目的:探讨动态增强磁共振(DCE-MRI)定量参数与乏氧诱导因子-1a(HIF-1a)预测食管鳞癌放化疗敏感性的价值。方法:对22例食管鳞癌患者行常规MRI、DWI、DCE-MRI检查及免疫组化染色。根据免疫组化结果分为HIF-1a阴性组(n=13)及HIF-1a阳性组(n=9),比较治疗前两组间DCE-MRI定量参数值之间的差异及治疗前后各参数值、肿块体积的差异。并以ROC曲线来评价治疗前Ktrans值区分HIF-1a阴性/阳性表达的效能。结果:1治疗前HIF-1a阴性组与阳性组间Ktrans值有显著差异(P=0.001);2治疗前后HIF-1a阴性组Ktrans值、肿块体积(V)有显著差异(P=0.002,P=0.001),而阳性组DCEMRI定量参数、肿块体积(V)无明显差异;3采用ROC曲线评价治疗前Ktrans值对判断食管鳞癌HIF-1a阴性/阳性表达的效能,曲线下面积为0.932,敏感性为100%,特异性为86.4%。结论:食管鳞癌HIF-1a阴性表达患者可能对放化疗更为敏感,治疗前Ktrans值对判断食管鳞癌HIF-1a阴性/阳性表达及对其放化疗敏感性的预测可能有一定的价值。

Purpose：To explore the value of the quantitative parameters of dynamic contrast-enhanced MRI （DCE-MRI） and the HIF-1a in predicting the sensitivity of chemoradiotherapy in esophageal squamous cell carcinoma （ESCC）. Methods： Conventional MRI, DWI, DCE-MRI and immunohistochemistry were performed in 22 ESCC patients. HIF-1a negative group （n=13） and HIF-1a positive group （n=9） were divided according to the immunohistochemistry results. The differences of quantitative parameters of DCE-MRI before treatment between the two groups were compared, and the differences of quantitative parameters and tumor volume （V） before and after treatment were also compared. ROC curves were used to evaluate the efficacy of pre-treatment Ktrans value in differentiating HIF-1 a negative and positive expression. Results： 1. The Ktrans value showed significant difference between HIF-1a negative group and positive group （P=0.001）. 2.The Ktrans value and V showed significant differences in HIF-1a negative group between before and after treatment （P=-0.002,P=0.001）, and none of the quantitative parameters and V showed significant differences in the HIF-1a positive group. 3. ROC curve was used to evaluate the efficacy of pre-treatment Ktrans value in differentiating HIF-1a negative and positive, the area under the curve, sensitivity and specificity was 0.932, 100%, 84.7%, respectively. Conclusion： ESCC patients with negative expression of HIF-1 a may be more sensitive to chemoradiotherapy, the pre-treatment Ktrans value might have value in differentiating HIF-1 a negative from positive, and predicting the chemoradiotherapy sensitivity for ESCC.