肢体ⅡB期骨肉瘤患者CT强化率评价化疗效果的临床研究

Evaluation of chemotherapy effect of limb osteosarcoma stageⅡB by CT enhancement rate

目的分析ⅡB期肢体骨肉瘤新辅助化疗前后,肿瘤CT强化率的变化特点及其与肿瘤坏死率的相关性,为评价骨肉瘤的化疗效果提供新的评价方法。方法2015年至2016年在我院接受治疗的肢体ⅡB期骨肉瘤77例。男52例,女25例,平均年龄18(6~53)岁。肿瘤部位包括股骨45例、胫骨20例、肱骨7例、腓骨2例、桡骨2例和尺骨1例。患者术前均接收甲氨蝶呤、顺铂+阿霉素、异环磷酰胺、甲氨蝶呤4周期化疗。化疗前后分别测量肿瘤相同层面的相同区域的平扫和增强CT值并计算CT强化率,比较化疗前后和不同坏死率分组的CT强化率及其变化情况。结果本组病例化疗前的平均CT强化率为1.67(中位1.62,1.00~2.94),化疗后的平均强化率为1.40(中位1.29,1.00~3.51),显著降低(P=0.000)。全部病例的CT强化率平均降低13.9%(中位16.1%,-27.5%~53.0%):其中55例降低,3例不变,19例升高。坏死率>90%组和<90%组的化疗前的平均CT强化率分别为1.72(中位1.67,1.32~2.41)和1.63(中位1.61,1.00~2.94),两组比较差异无统计学意义(P=0.310)。化疗后坏死率>90%组和<90%组的平均CT强化率分别为1.20(中位1.16,1.00~1.53)和1.53(中位1.44,1.00~3.51),两组比较差异有统计学意义(P=0.000)。坏死率>90%组的强化率平均降低27.9%(中位28.0%,-2.3%~53.0%),比化疗前显著降低(P=0.000);坏死率<90%组的强化率平均降低4.4%(中位1.0%,-27.5%~44.5%),与化疗前比较,无显著变化(P=0.225)。结论骨肉瘤接受新辅助化疗后,肿瘤的整体平均CT强化率显著降低。坏死率>90%组的强化率显著降低,而坏死率<90%组的强化率无显著变化。化疗后的CT强化率变化与肿瘤坏死率存在一定相关性,可以作为判断化疗效果的指标。

Objective To analyze the changes of CT enhancement rate and its correlation with tumor necrosis rate before and after neoadjuvant chemotherapy for stageⅡB limb osteosarcoma,so as to provide a new evaluation method for osteosarcoma chemotherapy.Methods From 2015 to 2016,77 patients with stageⅡB osteosarcoma of extremities were recruited.There were 52 males and 25 females with an average age of 18 years(range:6-53 years).Tumor locations:45 cases of the femur,20 cases of the tibia,7 cases of the humerus,2 cases of the fibula,2 cases of the radius and 1 case of the ulna.All patients received four cycles of preoperative chemotherapy including methotrexate,cisplatin+adriamycin,ifosfamide and methotrexate.The plain and enhanced CT values of the same area of the tumor were measured and the CT enhancement rate was calculated before and after chemotherapy.The CT enhancement rate and its changes were compared before and after chemotherapy and also in different necrosis rate groups.Results The average CT enhancement rate was significantly reduced from 1.67(median 1.62,1.00-2.94)before chemotherapy to 1.40(median 1.29,1.00-3.51)after chemotherapy(P=0.000).The CT enhancement rates of all cases decreased by 13.9%(median 16.1%,-27.5%-53.0%):55 cases decreased,3 cases remained unchanged and 19 cases increased.The pre-chemotherapy average CT enhancement rates were 1.72(median 1.67,1.32-2.41)and 1.63(median 1.61,1.00-2.94)in the necrosis rate>90%group and<90%group,respectively,and there were no significant differences between the two groups(P=0.310).The post-chemotherapy average CT enhancement rates in the necrosis rate>90%group and<90%group were 1.20(median 1.16,1.00-1.53)and 1.53(median 1.44,1.00-3.51),respectively,with significant differences between the two groups(P=0.000).In the necrosis rate>90%group,the enhancement rate decreased by 27.9%(median 28.0%,-2.3%-53.0%),which was significantly lower than that before chemotherapy(P=0.000);the enhancement rate of necrosis rate<90%group decreased by 4.4%(median 1.0%,-27.5%-44.5%)with no significant changes compared with that before chemotherapy(P=0.225).Conclusions The overall average CT enhancement rate of osteosarcoma decreases significantly after neoadjuvant chemotherapy.The enhancement rate in the group with necrosis rate>90%decreases significantly,while that in the group with necrosis rate<90%not.The CT enhancement rate showed a certain correlation with tumor necrosis rate after chemotherapy,which can be used as an indicator to judge the effect of chemotherapy.