CT灌注成像预测宫颈鳞癌新辅助化疗后预后高危因素的初步研究

A preliminary study on predicting the prognostic high-risk factors of cervical squamous cell carcinoma after neoadjuvant chemotherapy by CT perfusion imaging

目的:探讨CT灌注成像对宫颈鳞癌新辅助化疗后预后高危因素的预测价值。方法 :选取2011年5月-2015年8月在兰州大学第一医院接受新辅助化疗并手术的51例宫颈鳞癌患者,根据术后病理是否存在预后高危因素及短期预后将其分为无高危因素组(n=36,70.59%)和高危因素组(n=15,29.41%),对两组的CT灌注参数及临床资料作回顾性分析,探讨其对宫颈鳞癌新辅助化疗后预后高危因素的影响。结果:高危因素组中BF、化疗后肿瘤最大直径大于无高危因素组,差异有统计学意义(P<0.05),且与预后高危因素呈正相关(r=0.420,P=0.002;r=0.296,P=0.035)。FIGO分期、病理分级和化疗前肿瘤最大直径、BV、permeability、TTP与宫颈鳞癌新辅助化疗预后高危因素无相关性(P>0.05)。多因素Logistic回归分析及ROC显示BF为宫颈鳞癌新辅助化疗预后高危因素的独立影响因素并能够对其做出较为准确的预测AUC=0.810,P=0.001,95%CI(0.682~0.918)。结论:BF对宫颈鳞癌新辅助化疗后是否存在预后高危因素具有较高的预测价值。当BF≥46.64 mL/(100 m L·min)时,预测预后高危因素的敏感度、特异度和准确度分别为86.67%(13/15)、94.44%(34/36)和92.16%(47/51)。

Objective： To explore the predictive value of CT perfusion imaging for predicting the prognostic high-risk factors of cervical squamous carcinoma after neoadjuvant chemotherapy. Methods： The 51 patients who had cervical squamous carcinoma and underwent neoadjuvant chemotherapy before surgery between 2011 May and 2015 August in the First Hospital of Lanzhou University were selected. Based on the prognostic high-risk factors of pathology test and short-term prognosis, the cases were divided into two groups： non-high-risk factors（n=36, 70.59%） and high-risk group（n=15, 29.41%）. CT pcffusion pa- rameters and clinical data were retrospectively analyzed to investigate the high-risk prognostic factors. Results： Two indexes of the high-risk group cases, the BF （blood flow） and the maximum diameter of the tumor post chemotherapy, were statistically significant higher than another group（P〈0.05）. The high-risk prognostic factors were positively correlated with BF and the maximum diameter of tumor after neoadjuvant chemotherapy（r=0.420, P=0.002; r=0.296, P=0.035）. FIGO staging, pathological grade, the initial diameter of the tumor, BV, permeability and TTP were not correlated with the high-risk prognostic factors （P〉0.05）. Multivariate logistic regressionn analysis showed BF was an independent predictor to predict the existence of high-risk prognostic factors in cervical squamous carcinoma after neoadjuvant chemotherapy. BF can predict the？prognostic results accurately AUC=0.810, P=0.001, 95%CI（0.682-0.918）. Conclusion： BF had significant predictive value as a prognostic high-risk factor of cervical squamous carcinoma after neoadjuvant chemotherapy. Using BF equal to or greater than 46.64 mL/（100mL.min） to predict the existence of high-risk prognostic factors got 86.67%（13/15）, 94.44%（34/36） and 92.16%（47/51） in sensitivity, specificity and accuracy, respectively.