基于CT及病理构建胃间质瘤术后复发预测模型研究

Study on the construction of postoperative recurrence prediction model of gastric stromal tumor based on CT and preoperative pathology

目的:探讨CT征象结合病理预测胃间质瘤术后复发可行性。方法:搜集85例经手术病理证实胃间质瘤患者资料,统计分析不同CT征象及病理指标与复发关系,对有差异指标进行Logistic回归分析并构建预测模型,进而对模型预测价值进行评估。结果:复发组19例,未复发组66例。复发组与未复发组肿瘤形状(类圆形4/19 vs. 52/66,分叶状15/19 vs.11/66,不规则0/19 vs.3/66)、生长方式(腔内型8/19 vs. 49/66,腔外型8/19 vs.13/66,腔内外型3/19 vs. 4/66)、坏死囊变(18/19 vs.36/66)、肿瘤内出血(10/19 vs. 10/66)、表面溃疡(13/19 vs.15/66)、肿瘤内成熟血管(8/19 vs.9/66)、肿瘤最大径[(8.71±3.69)cm vs.(4.92±3.52)cm]、Ki-67[(22.68±20.46)%vs.(7.47±7.77)%]、有丝分裂指数(<5个/50HPF 6/19 vs. 51/66,6~10个/50HPF 5/19 vs. 9/66,>10个/50HPF 8/19 vs. 6/66)等差异有统计学意义(P<0.05)。肿瘤出血、肿瘤内成熟血管和有丝分裂指数为胃间质瘤术后复发独立预测因子。模型ROC曲线下面积0.935,阈值0.3254时,敏感度89.47%,特异度86.36%。结论:CT征象结合病理对评估胃间质瘤术后复发有一定价值。

Objective:To investigate the feasibility of CT signs combined with pathology to predict the postoperative recurrence of gastric stromal tumor.Methods:The data of 85 patients with gastric stromal tumor pathologically confirmed by operation were collected retrospectively.The differences of CT signs and pathological indexes between recurrent and non-recurrent group were analyzed.Logistic regression analysis was carried out on the indicators with statistical differences.The prediction model was constructed and the performance of the prediction model was evaluated.Results:There were 19 cases in recurrent group and 66 cases in non-recurrent group.Significant differences in tumor shape(round-like 4/19 vs.52/66,lobulated 15/19 vs.11/66,irregular 0/19 vs.3/66),growth pattern(intracavitary 8/19 vs.49/66,extracavitary 8/19 vs.13/66,intra-extracavitary 3/19 vs.4/66),cystic necrosis(18/19 vs.36/66),tumor bleeding(10/19 vs.10/66),surface ulcer(13/19 vs.15/66),mature blood vessels in tumor(8/19 vs.9/66),maximum tumor diameter(8.71±3.69cm vs.4.92±3.52cm),Ki-67(22.68±20.46%vs.7.47±7.77%)and mitotic index(<5/50HPF 6/19 vs.51/66,6~10/50HPF 5/19 vs.9/66,>10/50HPF 8/19 vs.6/66)between the recurrent group and the non-recurrent group(P<0.05)were detected.Tumor bleeding,mature vessels and mitotic index were independent predictors of postoperative recurrence of gastric stromal tumors.The area under the ROC curve was 0.935.When the threshold value was assigned as 0.33,the sensitivity and specificity were 89.47%and 86.36%,respectively.Conclusion:CT signs combined with preoperative pathology has a certain value in the prediction of postoperative recurrence of gastric stromal tumor.