动态增强MRI对进展期食管癌患者治疗疗效及预后的评估价值

Ealue of dynamic enhanced MRI in evaluating the therapeutic effect and prognosis of patients with advanced esophageal cancer

目的探讨动态增强MRI对进展期食管癌患者治疗疗效及预后的评估价值。方法选取84例进展期食管癌患者均接受放疗、化疗治疗,治疗前后均给予动态增强MRI扫描。比较不同治疗疗效、随访3年不同生存情况患者的动态增强MRI定量参数,包括容量转移常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积比(V_(e))。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估治疗前后K^(trans)对食管癌治疗疗效的评估价值;采用Kaplan-Meier法绘制生存曲线,比较治疗前后不同K^(trans)值患者的生存情况。结果84例进展期食管癌患者均顺利完成放化疗,完全缓解(CR)35例、部分缓解(PR)33例、疾病稳定(SD)16例、疾病进展(PD)0例,治疗总有效率为80.95%(68/84),将CR+PR患者纳入有效组(n=68),SD+PD患者纳入无效组(n=16)。有效组患者治疗前的K^(trans)明显高于无效组(P﹤0.01),治疗后的K^(trans)明显低于无效组(P﹤0.01)。随访3年,84例进展期食管癌患者生存60例、死亡24例,分别作为生存组和死亡组,生存组患者治疗前的K^(trans)明显高于死亡组(P﹤0.01),治疗后的K^(trans)明显低于死亡组(P﹤0.01)。ROC曲线结果显示,治疗前、治疗后K^(trans)预测食管癌治疗有效的AUC分别为0.873、0.890,最佳截断值分别为0.295 min^(-1)和0.275 min^(-1)。治疗前K^(trans)﹥0.295 min^(-1)患者的3年生存率为82.69%,高于K^(trans)≤0.295 min^(-1)患者的53.12%(P﹤0.05);治疗后K^(trans)≤0.275 min^(-1)患者的3年生存率为86.11%,高于K^(trans)﹥0.275 min^(-1)患者的60.42%(P﹤0.05)。结论动态增强MRI的K^(trans)参数对进展期食管癌患者放化疗有效的预测价值较高,治疗前后监测K^(trans)有利于及时预测治疗效果及预后,通过及时调整治疗方案改善患者的预后。

Objective To explore the value of dynamic enhanced MRI in evaluating the therapeutic effect and prognosis of patients with advanced esophageal cancer.Method Selected 84 patients with advanced esophageal cancer received radiotherapy and chemotherapy,and received dynamic enhanced MRI scans before and after treatment.The dynamic enhanced MRI quantitative parameters of patients with different treatment effects and 3 years of follow-up with different survival conditions were compared,including the volume transfer constant(K^(trans)),the rate constant(K_(ep)),and the extravascular extracellular space distribute volume per unit tissue volume(V_(e)).Draw the receiver operating characteristic(ROC)curve,calculate the area under the curve(AUC),and evaluate the evaluation value of K^(trans) before and after treatment on the therapeutic effect of esophageal cancer.The Kaplan-Meier method was used to draw survival curves to compare the survival of patients with different K^(trans) values before and after treatment.Result All 84 patients with advanced esophageal cancer successfully completed radiotherapy and chemotherapy,including 35 cases of complete response(CR),33 cases of partial response(PR),16 cases of stable disease(SD),and 0 case of progressive disease(PD),the total effective rate of treatment was 80.95%(68/84).Patients with CR+PR were included in the effective group(n=68),and patients with SD+PD were included in the ineffective group(n=16),the K^(trans) of the effective group before treatment was significantly higher than that of the ineffective group(P<0.01),and the K^(trans) after treatment was lower than that of the ineffective group(P<0.01).Follow-up for 3 years,84 patients with advanced esophageal cancer survived 60 cases and died 24 cases,respectively as survival group and death group.The K^(trans) of the survival group before treatment was significantly higher than that of the death group(P<0.01),and the K^(trans) after treatment was significantly lower than that of the death group(P<0.01).The ROC curve results showed that the AUC predicted by K^(trans) before and after treatment were 0.873 and 0.890,respectively,and the best cut-off values were 0.295 min^(-1) and 0.275 min^(-1),respectively.The 3-year survival rate of patients with K^(trans)>0.295 min^(-1) before treatment was 82.69%,which was higher than the 53.12% of patients with K^(trans)≤0.295 min^(-1)(P<0.05).After treatment,the 3-year survival rate of patients with K^(trans)≤0.275 min^(-1) was 86.11%,which was higher than the 60.42% of patients with K^(trans)>0.275 min^(-1)(P<0.05).Conclusion K^(trans) is of high predictive value for effective radiotherapy and chemotherapy in patients with advanced esophageal cancer.Monitoring K^(trans) before and after treatment is beneficial to timely predict curative effect and prognosis.The prognosis of patients can be improved by timely adjusting treatment plans.