腹部CT增强扫描与超声胃镜应用于胃癌新辅助化疗后分期准确性的比较

Accuracy comparision of abdominal enhanced CT and endoscopic ultrasound in the staging of gastric cancer after neoadjuvant chemotherapy:a post hoc analysis of a randomized clinical trial

目的比较腹部CT增强扫描与超声胃镜应用于胃癌新辅助化疗后分期的准确性。方法回顾性分析2015年4月23日至2017年11月23日86例于北京大学肿瘤医院行新辅助化疗后利用腹部CT增强扫描和超声胃镜进行肿瘤临床分期的进展期胃癌患者的资料。男性60例,女性26例,年龄(57.8±9.7)岁(范围:32~76岁)。以新辅助化疗后的病理学分期作为金标准,比较两者诊断新辅助化疗后临床T分期和N分期的准确性。采用多级受试者工作特征曲线下面积(M-AUC)计算两者的诊断效能,采用McNemar检验比较两者的灵敏度。结果新辅助化疗后腹部CT增强扫描诊断T分期(CT-ycT分期)的M-AUC为0.614,超声胃镜诊断T分期(EUS-ycT分期)的M-AUC为0.704。胃中部和下部癌CT-ycT分期的M-AUC分别为0.599和0.613,EUS-ycT分期的M-AUC分别为0.558和0.709。胃小弯和非胃小弯肿瘤CT-ycT分期的M-AUC分别为0.630和0.607,EUS-ycT分期的M-AUC分别为0.616和0.749。对于CT-ycT1期至CT-ycT4期患者,其CT-ycT分期和EUS-ycT分期的灵敏度分别为2/18、2/15、52.8%(19/36)、8/13比0、4/15、55.6%(20/36)、7/13,差异均无统计学意义(χ2=2.00,P=0.157;χ2=2.00,P=0.157;χ2=0.08,P=0.782;χ2=0.33,P=0.564)。CT-ycN分期和EUS-ycN分期的M-AUC分别为0.654和0.553。对于CT-ycN0患者,CT-ycN分期与EUS-ycN分期的灵敏度的差异有统计学意义[12.7%(7/55)比5.5%(3/55),χ2=4.00,P=0.046];对于CT-ycN1、N2、N3患者,CT-ycN分期与EUS-ycN分期的灵敏度差异均无统计学意义(2/19、1/10、0比1/19、1/10、0;χ2=1.00,P=0.317;后两者P值不可估)。结论腹部CT增强扫描与超声胃镜在胃癌新辅助化疗后分期的准确性方面无明显差异。考虑到超声胃镜的不耐受性,不推荐常规行超声胃镜检查。

Objective To compare the accuracy of abdominal enhanced CT and endoscopic ultrasound in the staging of gastric cancer after neoadjuvant chemotherapy(yc stage).Methods Clinic data of 86 locally advanced gastric cancer patients admitted in Gastrointestinal Cancer Center,Peking University Cancer Hospital&Institute from April 2015 to November 2017 were analyzed retrospectively.Totally 86 patients completed both abdominal enhanced CT and endoscopic ultrasound after neoadjuvant chemotherapy.There were 60 males and 26 females,aged(57.8±9.7)years(range:32 to 76 years).The diagnostic accuracy of abdominal enhanced CT and endoscopic ultrasound for yc stage were calculated by the area under the multiclass receiver operation characteristic curve(M-AUC),retrospectively.McNemar test was used to compared the diagnostic sensitivity.Results The M-AUC of ycT stage evaluated by abdominal enhanced CT(CT-ycT stage)and by endoscopic ultrasound(EUS-ycT stage)was 0.614 and 0.704,respectively.For middle and lower gastric cancer,the M-AUC of CT-ycT stage was 0.599 and 0.613,respectively,while EUS-ycT stage was 0.558 and 0.709,respectively.For tumor in the lesser and non-lesser curvature,the M-AUC of CT-ycT stage was 0.630 and 0.607,respectively,while EUS-ycT stage was 0.616 and 0.749,respectively.For patients in CT-ycT1-CT-ycT4,there was no statistically significant difference in the sensitivity between CT-ycT stage and EUS-ycT stage(2/18,2/15,52.8%(19/36),8/13 vs.0,4/15,55.6%(20/36),7/13;χ2=2.00,P=0.157;χ2=2.00,P=0.157;χ2=0.08,P=0.782;χ2=0.33,P=0.564).The M-AUC of ycN stage evaluated by abdominal enhanced CT(CT-ycN stage)was 0.654,while ycN stage evaluated by endoscopic ultrasound(EUS-ycN stage)was 0.533.For patients in CT-ycN0,there was statistically significant difference in the sensitivity between CT-ycN stage and EUS-ycN stage(12.7%(7/55)vs.5.5%(3/55);χ2=4.00,P=0.046).For patients in CT-ycN1,N2,and N3,there was no statistically significant difference in the sensitivity between CT-ycN stage and EUS-ycN stage(2/19,1/10,0 vs.1/19,1/10,0;χ2=1.00,P=0.317;the other P cannot be estimated).Conclusions There was no significant difference between the diagnostic efficacy of abdominal enhanced CT and endoscopic ultrasound for yc stage of gastric cancer.Considering the invasiveness of ultrasound gastroscopy,it should not be recommend for patients after neoadjuvant chemotherapy routinely.