基于多排螺旋CT的胰腺导管腺癌神经浸润评分与胰腺外神经侵犯的关系

Relationship between perineural invasion scores based on multidetector computed tomography and extrapancreatic perineural invasion in pancreatic ductal adenocarcinoma

目的探讨基于多排螺旋CT(MDCT)的胰腺导管腺癌(PDAC)神经浸润评分与胰腺外神经侵犯(EPNI)之间的关系。方法回顾性分析2018年3月至2020年5月间海军军医大学第一附属医院374例行根治性手术且术后病理证实为PDAC患者的临床、影像学和病理学资料,根据胰腺外神经是否侵犯的病理学结果将患者分为EPNI阴性组(111例)和阳性组(263例)。对患者的影像图像进行神经浸润评分,采用单因素和多因素logistic回归模型分析神经浸润评分与EPNI之间的相关性。结果EPNI阴性组和EPNI阳性组患者病理特征中的T分期、N分期、胆总管侵犯、切缘阳性及MDCT影像特征中的肿瘤大小、血管侵犯、淋巴结转移、MDCT神经浸润评分、胰腺轮廓、胰腺实质萎缩、侵犯十二指肠、侵犯脾脏和脾血管、侵犯胆总管的差异均有统计学意义(P值均<0.05)。单因素分析结果显示,肿瘤大小、血管侵犯、淋巴结转移、MDCT神经浸润评分、胰腺轮廓、实质萎缩、十二指肠侵犯、脾静脉及脾脏侵犯、胆总管侵犯均与EPNI显著相关。多因素分析结果显示,MDCT神经浸润评分与EPNI风险显著相关(评分为1分时的OR=2.93,95%CI1.61~5.32,P<0.0001;评分为2分时的OR=5.92,95%CI2.68~13.10,P<0.0001)。结论基于MDCT的神经浸润评分是PDAC发生EPNI的独立风险因素,可作为术前预测EPNI的评价指标。

Objective To investigate the relationship between the perineural invasion score based on multidetector computed tomography(MDCT)and extrapancreatic perineural invasion(EPNI)in pancreatic ductal adenocarcinoma(PDAC).Methods The clinical,radiological,and pathological data of 374 patients pathologically diagnosed as pancreatic cancer who underwent radical resection in the First Affiliated Hospital of Naval Medical University from March 2018 to May 2020 were analyzed retrospectively.Patients were divided into EPNI negative group(n=111)and EPNI positive group(n=263)based on the pathological presence of EPNI.The perineural invasion score was performed for each patient based on radiological images.Univariate and multivariate logistic regression models were used to analyze the association between the perineural invasion score based on MDCT and EPNI in PDAC.Results There were significant statistical differences between EPNI negative group and positive group on both pathological characteristics(T stage,N stage,invasion of common bile duct,and positive surgical margin)and radiological characteristics(tumor size,vascular invasion,lymph node metastasis,perineural invasion score based on MDCT,pancreatic border,parenchymal atrophy,invasion of duodenum,invasion of spleen and splenic vein and invasion of common bile duct)(all P value<0.05).Univariate analysis revealed that the tumor size,vascular invasion,lymph node metastasis,perineural invasion score based on MDCT,pancreatic border,pancreatic atrophy,invasion of duodenum,invasion of spleen and splenic vein and invasion of common bile duct were independently associated with EPNI.Multivariate analyses revealed that the perineural invasion based on MDCT was an independent risk factor for EPNI in pancreatic cancer(score=1,OR=2.93,95%CI 1.61-5.32,P<0.001;score=2,OR=5.92,95%CI 2.68-13.10,P<0.001).Conclusions The perineural invasion score based on MDCT was an independent risk factor for EPNI in pancreatic cancer and can be used as an evaluation indicator for preoperative prediction of EPNI in PDAC.