多层螺旋CT诊断食管鳞癌新辅助化疗后T分期的价值

Value of multi-slice spiral CT to the evaluation of T staging of advanced esophageal squamous cell carcinoma after neoadjuvant chemotherapy

目的应用多层螺旋CT(multi-slice spiral CT,MSCT)诊断食管鳞癌患者术前T分期,探讨其对术前行新辅助化疗患者T分期的诊断价值。方法食管鳞癌患者1079例,均行胸腹腔镜联合食管癌根治术,65例术前行新辅助化疗者为新辅助化疗组,1014例术前未行新辅助化疗者为单纯手术组。采用1∶1倾向性评分成功匹配64对患者,术前行MSCT检查并进行T分期。以术后组织病理检查结果为金标准,计算术前MSCT诊断食管鳞癌T分期的灵敏度、特异度、阳性预测值、阴性预测值、准确率;采用Kappa检验评估MSCT术前诊断食管鳞癌T分期与术后组织病理检查结果的一致性。结果倾向性评分匹配后新辅助化疗组年龄、性别、肿瘤位置与单纯手术组比较差异均无统计学意义(P>0.05)。新辅助化疗组术前MSCT诊断T_(0)、T_(1-2)、T_(3)、T_(4a)期的灵敏度分别为20%、74%、66%、100%,特异度分别为98%、64%、80%、100%,阳性预测值分别为50%、47%、84%、100%,阴性预测值分别为94%、85%、61%、100%,准确率分别为92%、67%、72%、100%;新辅助化疗组术前MSCT诊断T分期的总体准确率、灵敏度、特异度、阳性预测值、阴性预测值分别为66%、66%、89%、66%、89%,与术后组织病理结果的一致性较差(Kappa=0.389,P<0.001)。单纯手术组术前MSCT诊断T_(0)期的特异度为98%;诊断T_(1-2)、T_(3)期的灵敏度分别为83%、94%,特异度分别为94%、87%,阳性预测值分别为93%、89%,阴性预测值分别为86%、93%,准确率分别为89%、91%;单纯手术组术前MSCT诊断T分期的总体准确率、灵敏度、特异度、阳性预测值、阴性预测值分别为89%、89%、91%、91%、89%,与术后组织病理结果的一致性较好(Kappa=0.783,P<0.001)。新辅助化疗组术前MSCT诊断T_(1-2)期的特异度、准确率均低于单纯手术组(P<0.05),灵敏度与单纯手术组比较差异无统计学意义(P>0.05);新辅助化疗组术前MSCT诊断T_(3)期的灵敏度、准确率均低于单纯手术组(P<0.05),特异度与单纯手术组比较差异无统计学意义(P>0.05)。结论MSCT术前诊断未行新辅助化疗食管鳞癌患者T分期的准确率高于行新辅助化疗者。

Objective To evaluate the preoperative T staging of esophageal squamous cell cacinoma(ESCC)by multi-slice spiral CT(MSCT)and to investigate its value to T staging after neoadjuvant chemotherapy in patients with ESCC.Methods In 1079 patients with ESCC,1014 patients received with thoracolaparoscopy combined with radical resection of esophageal carcinoma(operation group)and 65 patients received neoadjuvant chemotherapy after thoracolaparoscopy combined with radical resection of esophageal carcinoma(neoadjuvant chemotherapy group).Sixty-four pairs of patients were successfully matched using 1∶1 propensity score matching.MSCT examination was done for T staging before operation.Taking the histopathological results as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of preoperative MSCT in evaluating T staging of ESCC were compared between two groups.Kappa test was used to evaluate the agreement between preoperative T staging by MSCT and the histopathological results.Results There were no significant differences in the age,gender and tumor location between two groups after propensity score matching(P>0.05).In neoadjuvant chemotherapy group,the sensitivities of MSCT in preoperative evaluation of stages T_(0),T_(1-2),T_(3) and T_(4a) were 20%,74%,66% and 100%,the specificities were 98%,64%,80% and 100%,the positive predictive values were 50%,47%,84% and 100%,the negative predictive values were 94%,85%,61% and 100%,and the accuracies were 92%,67%,72% and 100%,respectively.In neoadjuvant chemotherapy group,the overall accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of preoperative MSCT in T staging were 66%,66%,89%,66% and 89%,respectively,in apoor agreement with histopathologic results(Kappa=0.389,P<0.001).In operation group,the specificity of preoperative MSCT in evaluating stage T_(0) was 98%;the sensitivities in evaluating stage T_(1-2) and T_(3) were 83% and 94%,the specificities were 94% and 87%,the positive predictive values were 93% and 89%,the negative predictive values were 86% and 93%,and the accuracies were 89% and 91%,respectively.The overall accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of preoperative MSCT in T staging in operation group were 89%,89%,91%,91% and 89%,respectively,in a good agreement with histopathologic results(Kappa=0.783,P<0.001).The specificity and accuracy of preoperative MSCT in evaluating stage T_(1-2) were lower in neoadjuvant chemotherapy group than those in operation group(P<0.05),and there was no significant difference in the sensitivity between two groups(P>0.05).The sensitivity and accuracy of preoperative MSCT in evaluating stage T_(3) were lower in neoadjuvant chemotherapy group than those in operation group(P<0.05),and there was no significant difference in the specificity between two groups(P>0.05).Conclusion The accuracy of preoperative MSCT in T staging in ESCC patients receiving no neoadjuvant chemotherapy is higher than that in patients receiving neoadjuvant chemotherapy.