多期增强CT定量参数预测胃腺癌术后发生肝转移时间

Multi-Phase Enhanced CT Quantitative Parameters in Predicting the Time of Hepatic Metastasis in Gastric Adenocarcinoma After Operation

目的探讨多期增强CT定量参数对胃腺癌术后发生肝转移时间的预测价值。资料与方法回顾性分析经手术病理证实的胃腺癌372例,其中同时性肝转移(SHM)44例,异时性肝转移(MHM)53例,无任何转移征象275例(阴性转移组)。所有患者术前均行腹部增强CT三期增强扫描,比较3组患者性别、年龄、胃腺癌发生部位、手术方式、术后化疗情况、病理分型、组织分化程度、是否伴血管神经侵犯、人表皮生长因子受体-2表达水平、肿瘤标志物及术前多期增强CT定量参数与患者术后发生转移类型的关系,并绘制受试者工作特征曲线,分析多期增强CT定量参数预测胃腺癌术后肝转移时间的诊断效能。结果3组胃腺癌发生部位(χ^(2)=49.345,P<0.001)、肿瘤标志物升高[甲胎蛋白(χ^(2)=25.760,P<0.001)、癌胚抗原(χ^(2)=19.920,P<0.001)、糖类抗原19-9(χ^(2)=9.270,P<0.05)、糖类抗原125(χ^(2)=10.296,P<0.01)、糖类抗原72-4(χ^(2)=31.592,P<0.001)、美国癌症联合委员会病理T分期(χ^(2)=132.916,P<0.001)、N分期(χ^(2)=86.416,P<0.001)、术后化疗情况(χ^(2)=21.324,P<0.001)差异均有统计学意义。3组间峰值强化期相与肝转移组别之间有相关性(χ^(2)=59.884,P<0.001);进一步两两比较,强化峰值期相与肝转移Ⅲ期之间的相关性较弱(Cramer V=0.284,P<0.001)。受试者工作特征曲线分析显示,当动脉期的最佳截断值为81.5 Hu时,预测SHM的敏感度、特异度分别为88.6%、60.0%;当静脉期的最佳截断值为80.5 Hu时,预测MHM的敏感度、特异度分别为83.0%、42.0%。结论多期增强CT定量参数可用于预测胃腺癌术后发生肝转移的时间。当强化峰值出现在动脉期更倾向于SHM,强化峰值出现在延迟期更倾向于阴性转移。

Purpose To explore the value of multi-phase enhanced CT quantitative parameters in predicting the time of hepatic metastasis in patients with gastric adenocarcinoma after operation.Materials and Methods A total of 372 patients with gastric cancer confirmed by operation and pathology were retrospectively analyzed.There were 44 cases of synchronous hepatic metastasis(SHM),53 cases of metachronous hepatic metastasis(MHM)and 275 cases without any signs of metastasis(negative metastasis group).The abdominal enhanced CT scanning was performed in all patients before operation.The relationship between postoperative hepatic metastasis and sex,age,location of gastric cancer,mode of operation,postoperative chemotherapy,pathological classification,degree of tissue differentiation,vascular and nerve invasion,human epidermal growth factor receptor 2 expression,tumor markers and quantitative parameters of preoperative multi-phase enhanced CT were compared among the three groups.The receiver operating characteristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of multi-phase enhanced CT quantitative parameters in predicting the time of hepatic metastasis after operation in patients with gastric cancer.Results There were significantly differences in the location of gastric cancer(χ^(2)=49.345,P<0.01),the increase of tumor markers include alpha-fetoprotein(χ^(2)=25.760,P<0.001),carcinoembryonic antigen(χ^(2)=19.920,P<0.001),carbohydrate antigen 19-9(χ^(2)=9.270,P<0.05),carbohydrate antigen 125(χ^(2)=10.296,P<0.01),carbohydrate antigen 72-4(χ^(2)=31.592,P<0.001)and the TN stage of American Joint Committee on Cancer pathology(χ^(2)=132.916,86.416,P<0.001,respectively)among the three groups.There were significant correlations in the peak enhancement phase among the three groups(χ^(2)=59.884,P<0.001),and further analyses showed that there was weak correlation(Cramer V=0.284,P<0.001)between the peak enhancement phase and the three stages of hepatic metastasis.In ROC curve analysis,when the optimal cutoff value of arterial phase was 81.5 Hu,the sensitivity and specificity of predicting synchronous hepatic metastasis were 88.6%and 60.0%,respectively;when the optimal cutoff value of venous phase was 80.5 Hu,the sensitivity and specificity of predicting metachronous hepatic metastasis in venous phase were 83.0%and 42.0%,respectively.Conclusion The quantitative parameters of multi-phase enhanced CT could be used to predict the time of postoperative hepatic metastasis of gastric cancer.When the enhancement peak appeared in the arterial phase,it could be more inclined to SHM,while the enhancement peak appeared in the delayed phase could be more inclined to negative hepatic metastasis.