可切除胰腺导管腺癌CT强化程度与病理的相关性

Correlation of CT enhancement degree and pathology of resectable pancreatic ductal adenocarcinoma

目的分析胰腺导管癌(PDAC)增强CT强化程度与病理的关系,观察其对评估PDAC患者预后的价值。方法回顾性分析150例经术后病理证实的PDAC患者,术前均接受胰腺CT平扫及双期(实质期和门静脉期)增强扫描,测量增强CT双期肿瘤与周围胰腺实质的CT值差(实质期和门静脉期CT胰腺-肿瘤)及肿瘤强化后与平扫期CT值差(CT实质期-平扫期和CT门静脉期-平扫期),观察其与肿瘤分化程度及其内纤维间质含量的关系,分析PDAC患者生存时间的独立影响因素。结果实质期CT胰腺-肿瘤与肿瘤分化程度呈中度负相关(P<0.05),余各CT值差与分化呈低度相关(P均<0.05);实质期CT胰腺-肿瘤与肿瘤内纤维间质含量呈负相关(r=-0.51,P<0.05)。肿瘤分化程度、淋巴结转移、手术切缘状态为PDAC患者生存时间的独立危险因素(P均<0.05)。结论PDAC实质期CT胰腺-肿瘤与其病理级别及其内纤维间质含量均呈负相关;值差越小,病理级别越低,患者存活时间越长。

Objective To analyze the correlation of CT enhancement degree and pathology of pancreatic ductal adenocarcinoma(PDAC),and to observe its value for prognostic assessment.Methods Data of 150 patients with PDAC confirmed by pathology were retrospectively analyzed.All patients underwent preoperative CT plain scanning and double period(parenchymal phase and portal phase)enhanced scanning of pancreas.The CT value difference of PDAC and peripheral pancreatic parenchyma(parenchymal phase and portal phase CT pancreas-tumor),as well as that of tumor enhancement and plain scan(CT parenchymal phase-plain phase,CT portal phase-plain phase)were measured.Correlation of all CT value differences and pathological differentiation or content of fibrous stroma within PDAC were observed,and the independent impact factors of survival time of PDAC patients were analyzed.Results There was a moderate correlation between parenchymal phase CT pancreas-tumor and pathological differentiation but low correlation among the remaining CT value differences and pathological differentiation of PDAC(all P<0.05).Parenchymal phase CT pancreas-tumor was negatively correlated with content of fibrous stroma(r=-0.51,P<0.05).Tumor differentiation,lymph node metastasis and surgical margin status were independent risk factors of survival time of PDAC patients(all P<0.05).Conclusion Parenchymal phase CT pancreas-tumor of PDAC was negatively correlated with pathological differentiation and content of fibrous stroma.The smaller CT value difference indicates,the lower pathological staging and the longer survival time were.