改进胃癌临床T分期模型的建立与评价

Establishment and evaluation of the revised clinical T staging model for patients with gastric cancer

目的建立改进的胃癌临床T分期模型,并对其预测效果进行评价,为改善临床T分期预测价值提供依据。方法选取接受根治性手术的胃癌患者227例,其中102例为pT1~pT2期,125例为pT3~pT4期,患者术前均行超声内镜(EUS)及多层螺旋CT检查。比较pT1~pT2期和pT3~pT4期患者性别、年龄、肿瘤位置、Borrmann分型、基于CT的T分期、EUS下肿瘤侵犯胃壁层数、EUS肿瘤纵切面最大短径等临床及病理特征的差异。根据临床经验纳入基于CT的T分期、EUS下肿瘤侵犯胃壁层数建立传统的常规临床T分期Logistic回归模型。将单因素分析有意义的指标进行多因素Logistic回归分析,评价pT3~pT4期胃癌的影响因素并建立改进临床T分期Logistic回归模型。绘制受试者工作特征(ROC)曲线评价常规临床T分期模型与改进的临床T分期模型的预测效果。结果常规临床T分期模型为Logit(P)=-2.599+2.409×基于CT的T分期+2.553×EUS下肿瘤侵犯胃壁层数。单因素分析与多因素Logistic回归分析显示,基于CT的T3~T4分期(OR=12.528,95%CI:4.347~36.109)、EUS下肿瘤侵犯胃壁第5层(OR=7.533,95%CI:2.539~22.353)、较长EUS肿瘤纵切面最大短径(OR=31.084,95%CI:8.681~111.307)为pT3~pT4的独立影响因素。以这3个变量建立改进临床T分期模型Logistic回归方程为Logit(P)=-7.884+2.528×基于CT的T分期+2.019×EUS下肿瘤侵犯胃壁层数+3.437×EUS肿瘤纵切面最大短径。改进临床T分期模型预测pT3~pT4期的临床价值优于常规临床T分期模型(AUC:0.952 vs. 0.891;Z=3.870,P<0.01)。在淋巴结阳性亚组中,改进临床T分期模型的预测价值亦优于常规临床T分期模型(AUC:0.916 vs. 0.864;Z=2.058,P<0.05)。结论改进后的临床T分期模型可更好地预测胃癌患者的病理T分期,为患者的个体化治疗提供可靠依据。

Objective To establish a new clinical T staging model for patients with gastric cancer(GC)and to evaluate its predictive effect,so as to provide the basis for improving the predictive value of clinical T staging.Methods A total of 227 GC patients underwent radical surgery in our hospital were enrolled in this study.Among them,102 cases were pTl-pT2 gastric cancer,125 cases were pT3-pT4 gastric cancer.All patients underwent endoscopic ultrasonography(EUS)and multislice spiral computed tomography(CT)examination before operation.Univariate analysis was used to compare the clinical and pathological data,including gender,age,tumor location,Borrmann classification,CT based T staging,the layers of tumor invading the gastric wall under EUS and the maximum short diameter of longitudinal section of tumor under EUS,between pTl-pT2 and pT3-pT4 patients.According to the clinical experience,CT-based T staging and the layers of tumor invading the gastric wall under EUS were included to establish the traditional conventional clinical T staging model(CCTSM).Multivariate Logistic regression analysis was used to further evaluate the risk factors of pT3-pT4 after univariate analysis,and the significant variables were included in the revised clinical T staging model(RCTSM).The receiver operating characteristic(ROC)curve was constructed to assess the performance of two prediction models.Results The corresponding Logistic regression equation was Logit(P)=-2.599+2.409×CT based T staging+2.553 x the layers of tumor invading the gastric wall under EUS.The results of univariate analysis and multivariate Logistic regression analysis showed that CT based T3-T4 staging(OR=12.528,95%CI:4.347-36.109),the 5 th layer of tumor invading the gastric-wall under EUS(OR=7.533,95%CI:2.539-22.353),the longer maximum of the short diameter of tumor longitudinal section under EUS(OR=31.084,95%CI:8.681-111.307)were independent risk factors of pT3-pT4 stage in the GC patients.The Logistic regression equation of the revised clinical T staging model was established with these three variables:Logit(P)=-7.884+2.528×CT based T staging+2.019×the layers of tumor invading the gastric wall under EUS+3.437×the maximum short diameter of longitudinal section of tumor under EUS.The clinical value of the RCTSM in predicting pT3~pT4 was better than that of the CCTSM(AUC:0.952 vs.0.891,Z=3.870,P<0.01).In the lymph node positive subgroup,the predictive value of the RCTSM-was also better than that of the CCTSM(AUC:0.916 vs.0.864,Z=2.058,P<0.05).Conclusion The RCTSM can better predict the pathological T staging in patients with gastric cancer and provide reliable basis for individualized treatment of GC patients.