双重造影增强超声Qontra Xt三维伪彩色定量分析评价进展期胃癌新辅助化疗疗效的价值

Value of double contrast-enhanced ultrasound QontraXt three-dimensional pseudocolor quantitative analysis to therapeutic effect evaluation of preoperative neoadjuvant chemotherapy in advanced gastric cancer patients

目的探讨超声双重造影（DCEUS）QontraXt三维伪彩色定量分析肿瘤组织血流灌注参数及其变化评价进展期胃癌新辅助化疗（NAC）疗效的价值。方法89例进展期胃癌患者，接受3个疗程NAC（奥沙利铂＋卡培他滨）联合手术治疗。分别于化疗前和手术前1～2周行DCEUS检查和QontraXt三维伪彩色定量分析，比较NAC前后、反应组和无反应组之间，峰值强度（PE）、达峰时间（TP）、伽马曲线的尖度（β）、曲线下面积（AUC）等造影参数及其变化率的差异。绘制受试者工作特征（ROC）曲线，估计诊断指标的最佳界值，计算相应的灵敏度和特异度。结果89例患者中，NAC反应组52例，无反应组37例。反应组黏液性癌12例，非黏液性癌40例；无反应组黏液性癌26例，非黏液性癌11例；差异有统计学意义（P〈0.05）。反应组化疗前PE、TP分别为（53.7±9.3）%和（14 521±2 667）ms，化疗后PE、TP分别为（32.2±5.5）%和（17 235±1 898）ms，ΔPE/PE化疗前、ΔTP/TP化疗前分别为0.43±0.17和0.36±0.14；无反应组化疗前PE、TP分别为（54.4±7.2）%和（13 869±3 247）ms，化疗后PE、TP分别为（45.3±6.1）%和（15 127±1 423）ms，ΔPE/PE化疗前、ΔTP/TP化疗前分别为0.24±0.20和0.22±0.12；两组间化疗后PE和TP、ΔPE/PE化疗前和ΔTP/TP化疗前差异有统计学意义（均P〈0.05）。ROC曲线分析显示，ΔPE/PE化疗前评估胃癌NAC病理反应程度的价值最高（曲线下面积为0.784，P＝0.004），当ΔPE/PE化疗前最佳界值为24%时，其预测胃癌NAC有效的灵敏度为82.7%，特异度为64.9%。结论超声双重造影QontraXt三维伪彩色定量分析肿瘤组织血流灌注参数变化可以有效评估进展期胃癌的NAC疗效。

ObjectiveTo investigate the value of tumor perfusion parameter measured by using double contrast-enhanced ultrasound （DCEUS） QontraXt three-dimensional pseudocolor quantitative analysis to the therapeutic effect evaluation of preoperative neoadjuvant chemotherapy （NAC） in advanced gastric cancer （AGC） patients.MethodsEighty-nine AGC patients underwent 3 cycles of preoperative NAC （XELOX） followed by complete resection of lesion. The DCEUS QontraXt three-dimensional pseudocolor was performed one or two weeks before the NAC and operation were applied, respectively. The peak enhancement （PE）, time to peak （TP）, sharpness of the bolus （β） and area under the enhancement curve （AUC） of primary gastric tumor were measured by QontraXt three-dimensional pseudocolor quantitative analysis. These DCEUS parameters between respond and non-respond groups before and after NAC therapy were compared. The prediction accuracy of DCEUS to the therapeutic effect evaluation of preoperative NAC was determined by the receive operating characteristic （ROC） curves.ResultsAmong 89 AGC patients, 52 patients responded to NAC therapy, while 37 patients resisted to NAC therapy. Twelve cases in respond group and 26 cases in non-respond group were mucinous carcinoma. Forty cases in respond group and 11 cases in non-respond group were non-mucinous carcinoma （P〈0.05）. In responder group, the PE and TP before NAC were （53.7±9.3）% and （14 521±2 667） ms, and （32.2±5.5）% and （17 235±1 898） ms after NAC. The ratio of changes of PE （ΔPE） and TP （ΔTP） were 0.43±0.17 and 0.36±0.14, respectively. In non-respond group, the PE and TP before NAC were （54.4±7.2）% and （13 869±3 247） ms, and （45.3±6.1）% and （15 127±1 423） ms after NAC therapy. The ratio of ΔPE and ΔTP were 0.24±0.20 and 0.22±0.12. The PE and TP after NAC, the ratio of ΔPE and ΔTP were significant different among these two groups （all of P〈0.05）. The ROC curves showed that the ratio of ΔPE in assessing the respond of gastric cancer patients to NAC was superior compared to other parameters （AUC=0.784, P=0.004）. The optimal cut-off value of the ratio of ΔPE was 24% and its sensitivity and specificity to the therapeutic effect evaluation of NAC in gastric cancer were 82.7% and 64.9%.ConclusionDCEUS QontraXt three-dimensional pseudocolor quantitative analysis might be a novel, noninvasive and reliable method to evaluate the therapeutic effect of preoperative NAC in AGC patients.