经直肠超声联合表观弥散系数预测直肠癌新辅助化疗后缓解的价值

Value of endorectal ultrasound combined with apparent diffusion coefficient in predicting remission of rectal cancer after neoadjuvant chemotherapy

目的探讨经直肠超声(ERUS)联合表观弥散系数(ADC)预测直肠癌新辅助化疗后完全缓解(pCR)的价值。方法回顾性分析于我院行新辅助化疗的118例直肠癌患者的临床检查资料,所有患者均于新辅助化疗前及化疗后8周行ERUS检查和弥散加权成像检查,观察ERUS测得的肿瘤距肛缘距离、肿瘤长度和厚度变化情况,获得化疗前后ADC。采用Speaman相关性分析法分析ERUS参数、ADC与肿瘤退缩分级(TRG)的相关性;绘制受试者工作特征(ROC)曲线评估ERUS参数联合ADC对直肠癌新辅助化疗后pCR的预测价值。结果新辅助化疗后疗效评估结果显示,TRG 0、TRG 1、TRG 2、TRG 3级分别为35、26、45、12例;pCR组35例,非pCR组83例。pCR组与非pCR组化疗前后肿瘤距肛缘距离、肿瘤长度和厚度、ADC比较差异均有统计学意义(均P<0.001);组内比较显示,化疗后两组肿瘤距肛缘距离、ADC均高于化疗前,肿瘤长度和厚度均小于化疗前,差异均有统计学意义(均P<0.001)。Spearman相关性分析显示,肿瘤距肛缘距离、ADC与TRG均呈负相关(r=-0.459、-0.720,均P<0.05),肿瘤长度和厚度与TRG均呈正相关(r=0.471、0.397,均P<0.05)。ROC曲线分析结果显示,肿瘤距肛缘距离、肿瘤长度和厚度、ADC预测直肠癌新辅助化疗后pCR的曲线下面积分别为0.817、0.683、0.857、0.742,联合应用预测的曲线下面积为0.994。结论ERUS联合ADC对直肠癌新辅助化疗后pCR有较好的预测价值。

Objective(ADC)in predicting pathologic complete remission(pCR)of rectal cancer after neoadjuvant chemotherapy.Methods clinicopathological data of 118 patients with rectal cancer who received neoadjuvant chemotherapy in our hospital were retrospectively analyzed.All patients underwent ERUS and diffusion-weighted imaging before and 8 weeks after neoadjuvant chemotherapy.The changes of the distance from the tumor to anal verge,tumor length and thickness were measured by ERUS,and the ADC was calculated before and after chemotherapy.The correlation between ERUS parameters,ADC and tumor regression grade(TRG)was analyzed by Spearman correlation analysis.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of ERUS parameters combined with ADC for pCR after neoadjuvant chemotherapy for rectal cancer.ResultsThe results after neoadjuvant chemotherapy showed that TRG 0,TRG 1,TRG 2 and TRG 3 were 35,26,45 and12 cases,respectively.There were 35 cases in the pCR group and 83 cases in the non-pCR group.There were significant differences in ADC,distance from tumor to anal verge,tumor length and thickenss between the pCR group and the non-pCR group before and after chemotherapy(all P<0.001).The intra group comparison showed that the distance from tumor to anal verge and the ADC in two groups after chemotherapy were higher than those before chemotherapy,and the tumor length and thickness were lower than those before chemotherapy.The difference were statistically significant(all P<0.001).Spearman correlation analysis showed that the distance from tumor to anal verge and ADC were negatively correlated with TRG(r=-0.459,-0.720,both P<0.05),while tumor length and thickness were positively correlated with TRG(r=0.471,0.397,both P<0.05).The results of ROC curve analysis showed that the area under the curve of the distance from the tumor to anal verge,tumor length and thickness,ADC for predicting pCR after neoadjuvant chemotherapy for rectal cancer were 0.817,0.683,0.857 and 0.742,respectively,and AUC of combined application was 0.994.ConclusionERUS combined with ADC has high predictive value for pCR of rectal cancer after neoadjuvant chemotherapy.