食管鳞癌新辅助化疗前后淋巴结CT表现及其预测术后pN分期的价值

CT manifestations of lymph nodes before and after neoadjuvant chemotherapy for esophageal squamous cell carcinoma and the value for predicting postoperative pN staging

目的观察新辅助化疗(NACT)前后食管鳞癌淋巴结CT表现,并分析其预测术后pN分期的效能。方法回顾性分析124例经胃镜活检病理确诊食管鳞癌并接受NACT患者化疗前后CT资料。比较NACT前后淋巴结总数、最大长/短径、长/短径均值、长/短径变异系数(CV),绘制NACT前后不同大小淋巴结所占比例分布图。应用受试者工作特征(ROC)曲线方法分析不同淋巴结径线标准下阳性淋巴结数目预测食管鳞癌术后pN分期的效能。结果食管鳞癌NACT前后淋巴结总数、最大长/短径、长/短径均值差异均有统计学意义(P均<0.01),而淋巴结长/短径CV差异均无统计学意义(P均>0.05)。NACT前后不同大小淋巴结分布比例无明显变化。ROC曲线结果显示,以NACT前后不同径线为标准判断阳性淋巴结数目预测术后pN分期的曲线下面积(AUC)为0.65~0.71。结论NACT前后食管鳞癌患者淋巴结CT表现存在一定差异;针对不同径线淋巴结采用相应标准判断的阳性淋巴结数目有助于预测术后pN分期。

Objective To observe the manifestations of lymph nodes in esophageal carcinoma patients before and after neoadjuvant chemotherapy(NACT)and the value for predicting postoperative pN staging.Methods CT data of 124 esophageal squamous cell carcinoma patients diagnosed with biopsy were retrospectively analyzed before and after NACT.The number of lymph nodes,the maximum long/short diameter,the mean long/short diameter and long/short diameter variation coefficient(CV)were compared before and after NACT.The proportions of different sizes lymph nodes were analyzed before and after NACT,and receiver operating characteristic(ROC)curves were drawn to explore the efficacy of the number of positive lymph nodes under criteria of different diameter lymph nodes for predicting postoperative pN staging of esophageal squamous cell carcinoma.Results There were statistical differences of the number of lymph nodes,the maximum long/short diameter and the mean long/short diameter before and after NACT(all P<0.01),but not of CV of the long/short diameter of lymph nodes(both P>0.05).The distribution ratio of different sizes lymph nodes did not change obviously after NACT.ROC curve results showed that before and after NACT,the area under the curve(AUC)of the number of positive lymph nodes for predicting postoperative pN staging was 0.65 to 0.71.Conclusion CT manifestations of lymph nodes in patients with esophageal squamous cell carcinoma were somehow different after NACT,and the number of positive lymph nodes judged with different criteria of various diameter lymph nodes might help to predict postoperative postoperative pN staging.