CT纹理分析对于结直肠癌肝转移患者行挽救性肝动脉灌注化疗疗效的预测价值

Predictive value of CT texture analysis in salvage hepatic arterial infusion chemotherapy for patients with liver metastases after radical resection of colorectal cancer

目的探讨CT纹理分析对结直肠癌术后肝转移患者肝转移灶行挽救性肝动脉灌注(HAI)化疗疗效的预测价值。方法回顾性分析2013年4月至2018年4月收治的45例结直肠癌术后肝转移行一线化疗后肝内病灶进展的患者,所有患者均行2个周期伊立替康联合氟尿嘧啶挽救性HAI化疗。治疗前对于可评估肝转移灶及周围无病变肝组织门脉期CT图像行纹理分析,提取纹理特征参数包括均值、峰度、偏度、熵。按照RECIST 1.1标准,分别将患者和病灶分为控制组和进展组,比较两组之间CT纹理特征参数,评估CT纹理分析结果对于HAI化疗疗效的预测价值。结果按患者肿瘤控制情况分组,分为控制组32例和进展组13例。两组患者病灶在均值、峰度、偏度、熵之间的差异均无统计学意义(P>0.05)。两组患者周围无病变肝组织在均值、峰度、偏度之间的差异均无统计学意义(P>0.05);进展组熵值(2.30±0.19)高于控制组(1.99±0.25),差异有统计学意义(P<0.001)。按单病灶控制程度分组,控制病灶112枚,进展病灶32枚。两组病灶在均值、峰度、偏度之间的差异均无统计学意义(P>0.05);进展组熵值(2.56±0.16)高于控制组(2.23±0.19),差异有统计学意义(P<0.001)。以单病灶熵值结果绘制受试者工作特征(ROC)曲线,曲线下面积为0.814,灵敏度79.6%,特异度为77.8%,最大约登指数为0.574,对应熵值为2.23。结论转移灶及周围无病变肝组织的CT纹理分析结果对于结直肠癌肝转移患者行挽救性HAI化疗的疗效具有一定的预测价值。

Objective To investigate the predictive value of CT texture analysis in salvage hepatic artery infusion(HAI) chemotherapy for patients with liver metastases after radical resection of colorectal cancer. Methods A retrospective analysis of 45 patients with liver metastases progression after radical resection of colorectal cancer and first-line chemotherapy from April 2013 to April 2018. All patients were treated with 2 cycles of salvage HAI chemotherapy(irinotecan combined with fluorouracil). Before treatment, all evaluable metastases, as well as the whole-volume of the surrounding liver, were separately analyzed on the portal venous phase primary staging CT. Texture features including means, kurtosis, skewness, and entropy were extracted and calculated. The patients and the lesions were divided into control group and progression group respectively according to the RECIST 1.1 version. The texture features were compared between the two groups and the predictive value of texture analysis for the patients with HAI chemotherapy was evaluated. Results According to the short-term efficacy,patients were divided into control group(n=32) and progress group(n=13). There was no significant difference in means, kurtosis, skewness and entropy between the two groups, neither in means, kurtosis, skewness for whole-volume of the surrounding liver(P>0.05). But there was significant difference in entropy for whole-volume of the surrounding liver between control group and progression group(1.99±0.25 vs. 2.30±0.19,P<0.001). According to the control degree of single lesion, lesions were classified into control group(n=112) and progression group(n=32). There was no significant difference in mean, kurtosis and skewness between the two groups, but there was significant difference in entropy between control group and progression group(2.23±0.19 vs. 2.56±0.16, P<0.001). The receiver operating characteristic(ROC) curve was drawn with the result of single lesion entropy. The area under the curve was 0.814, the sensitivity was 79.6%, the specificity was 77.8%, the Youden index was 0.574 and the corerresponding entropy was 2.23. Conclusion For patients with liver metastases after radical resection of colorectal cancer, CT texture analysis of the metastases and the whole-volume of surrounding liver, may be of value to predict prognosis of salvage hepatic artery infusion chemotherapy.