Revolution CT灌注成像对胃癌Lauren分型及预后相关因子的术前定量评估

Preoperative quantitative evaluation of gastric cancer by revolution CT perfusion in Lauren typing and prognostic factors

目的:探讨Revolution CT灌注成像对胃癌Lauren分型及预后相关因子的术前定量评估价值。方法:收集经胃镜活检确诊为胃癌的患者52例,行CT灌注扫描,获取术前CT灌注参数及术后病理资料。按照Lauren分型将入组病例分为肠型组、弥漫型组及混合型组,按照HER2及EGFR表达情况分别分为HER2阳性组、HER2阴性组及EGFR表达0组、1+组、2+组、3+组。使用单因素方差分析不同CT灌注参数差别在Lauren分型,HER2和EGFR不同表达之间的差别。并绘制混合型胃癌和HER2阳性的受试者工作特性(ROC)曲线,评估相关CT灌注参数的诊断效能并得出诊断的最佳界值。结果:PS及BV在胃癌Lauren分型中混合型的数值高于肠型及弥漫型(P<0.05)。其中PS预测胃癌患者的Lauren分型中混合型的诊断效能最好,曲线下面积(AUC)可达0.962,以45.23 mL/100 g/min为界值点,敏感度、特异度分别为94.7%、93.9%。BV及PS在HER2阴性组及阳性组间差别有统计学意义。BV及PS诊断HER2阳性胃癌ROC曲线下面积分别为0.762及0.735。CT灌注参数在不同EGFR表达胃癌中差别无显著统计学差异(P>0.05)。结论:CT灌注成像可以对胃癌术前Lauren分型中混合型进行较准确的定量的评价,且对于胃癌相关预后指标HER2有一定的定量评估价值。

Objective:To explore the feasibility of CT perfusion parameters in distinguishing the Lauren types and prognostic factors in gastric cancer preoperatively.Methods:Fifty-two patients confirmed of gastric cancer with gastroscopy were examined preoperative perfusion CT(PCT)and curative gastrectomy.The enrolled cases were divided into intestinal group,diffuse group and mixed group according to Lauren classification.Patients were also divided according to HER2 expression in term of positive and negative group,as well as 0 group,1+group,2+group and 3+group according to the express state of EGFR.One-way analysis of variance(ANOVA)were performed in each group.A receiver operating characteristic(ROC)analysis was applied to evaluate the diagnostic performance of meaningful parameters.Results:PS and BV of mixed group was significantly higher than those of other Lauren types(P<0.05).PS showed the highest area under ROC curve(AUC)of 0.962(sensitivity,94.7%;specificity,93.9%).There were statistical differences in PS and BV between HER2 positive group and negative group.The area under the ROC curve for the diagnosis of HER2 positive gastric cancer by BV and PS was 0.762 and 0.735,respectively.There was no statistically significant difference in all CT perfusion parameters in different EGFR expression(P>0.05).Conclusion:PCT can accurately evaluate the Lauren typing and HER2 expression of gastric cancer.