螺旋CT术前预测直肠癌系膜浸润程度及预后的价值

Value of Spiral Computed Tomography on Preopetative Prediction of Tumor Infiltration and Prognosis in Patients with Rectal Cancer

目的:探讨多层螺旋CT术前预测直肠癌系膜浸润及预后的价值。方法:选取78例经病理确诊并且临床资料完整的直肠癌患者,术前行16排多层螺旋CT(MSCT)检查,并与术后病理检查结果进行对比,分析MSCT预测直肠癌系膜浸润程度的准确度、敏感度和特异度。术后定期随访,分析不同MSCT预测直肠癌系膜浸润程度患者的总体生存率。结果:MSCT诊断直肠癌系膜浸润程度的总准确度为87.18%(68/78)。预测Ⅰ、Ⅱ、Ⅲ度直肠系膜浸润程度的准确度分别为86.11%(31/36)、85.00%(17/20)和90.91%(20/22);灵敏度分别为96.88%(31/32)、73.91%(17/23)和86.96%(20/23);特异度分别为89.13%(41/46)、94.55%(52/55)和96.36%(53/55)。MSCT预测的直肠癌系膜浸润程度与肿瘤直径和肿瘤分期显著相关(P<0.05)。生存分析结果显示,不同MSCT预测直肠癌系膜浸润程度患者的术后总体生存率存在差异,表现为Ⅰ度最高,Ⅱ度次之,Ⅲ度最低,且差异有统计学意义(X^2=22.923,P<0.001)。结论:MSCT术前诊断直肠癌系膜浸润程度具有较高的价值,并能作为判断预后的重要指标,从而指导临床治疗方案的选择。

Objective： To investigate the value of multislice spiral computed tomography （ MSCT ） on preopetative prediction of tumor infiltration and prognosis in patients with rectal cancer.Method： A total of 78 patients with rectal cancer comfirmed by pathology and complete clinical data were selected.All eases underwent preoperative examination by 16-row MSCT, and the results were compared with the postoperative pathological findings.The accuracy, sensitivity, and specificity of MSCT on diagnosing tumor infiltration were evaluated. The total survival rates of patients with different degrees of tumor infiltration were also calculated and compared. Result： The total accuracy of diagnosis was 87.18% （ 68/78 ） .For degree I, II, llI of tumor infiltration, the accuracy were 86.11% （ 31/36 ）, 85.00% （ 17/20 ）, and 90.91% （ 20/22 ）, the sensitivity were 96.88% （ 31/32 ）, 73.91% （ 17/23 ）, and 86.96% （ 20/23 ）, while the specificity were 89.13% （ 41/46 ）, 94.55% （ 52/55 ）, and 96.36% （ 53/55 ） .The degree of tumor infiltration by MSCT was significantly associated with tumor stage and tumor volume （ P〈0.05 ） .Survival analysis showed that, the postoperative survival rates of patients with different degree of tumor infiltration were extremely different, which appeared as the highest in patients with degree Ⅰ, followed by degree Ⅱ, and the lowest in degree Ⅲ （ X2=22.923, P〈0.001 ） .Conclusion： MSCT has a high value on preoperative prediction of tumor infiltration in patients with rectal cancer, and can be a useful tool for judging prognsis, thus guiding the choise of clinical treatment.