动态增强磁共振成像对初诊鼻咽癌患者调强放疗预后的评估价值

Prognostic value of dynamic contrast enhanced magnetic resonance imaging in patients with newly diagnosed nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

目的研究动态增强磁共振成像(DCE-MRI)对初诊鼻咽癌患者调强放射治疗(IMRT)预后的评估价值。方法选取2016年1月—2021年12月南通市第二人民医院收治的82例初诊鼻咽癌患者,均行IMRT。IMRT前行DCE-MRI检查,计算K^(trans)值、K_(ep)值、V_(e)值、V_(p)值。IMRT结束后3个月根据临床疗效将患者分为良好组52例,不良组30例,比较良好组与不良组IMRT前的DCE-MRI参数及临床资料;采用多因素逐步Logistic回归分析IMRT预后不良的危险因素;绘制受试者工作特征(ROC)曲线,评价DCE-MRI参数对初诊鼻咽癌患者IMRT预后的预测价值。结果不良组IMRT前K^(trans)、K_(ep)较良好组缩短(P<0.05);不良组贫血,原发灶大小为超腔,T分期为T_(3)、T_(4),咽后淋巴结转移较良好组升高(P<0.05);Logistic回归分析结果显示,贫血[OR=1.732(95%CI:1.269,2.194)],原发灶大小为超腔[OR=1.489(95%CI:1.254,1.724)],咽后淋巴结转移[OR=2.659(95%CI:2.013,3.305)],T分期为T_(3)、T_(4)[OR=3.504(95%CI:1.987,5.022)],K^(trans)[OR=5.865(95%CI:3.145,8.585)]和K_(ep)[OR=3.142(95%CI:2.412,3.873)]均为初诊鼻咽癌IMRT患者预后不良的危险因素(P<0.05)。ROC结果显示,K^(trans)预测初诊鼻咽癌IMRT患者预后不良的最佳截断值为0.22 min,AUC为0.728(95%CI:0.618,0.820),敏感性为80.00%(95%CI:0.754,0.846),特异性为82.69%(95%CI:0.792,0.862);K_(ep)预测初诊鼻咽癌患者IMRT预后不良的最佳截断值为0.71 min,AUC为0.746(95%CI:0.637,0.835),敏感性为76.67%(95%CI:0.698,0.836),特异性为75.00%(95%CI:0.671,0.829);两者联合预测预后不良的AUC为0.762(95%CI:0.655,0.849),敏感性为76.67%(95%CI:0.712,0.821),特异性88.46%(95%CI:0.804,0.965)。结论DCE-MRI中K^(trans)、K_(ep)对初诊鼻咽癌患者IMRT预后具有一定预测价值,可为临床个体化治疗及治疗方案的修正提供依据。

Objective To study the prognostic value of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)in newly diagnosed nasopharyngeal carcinoma patients with intensity-modulated radiotherapy(IMRT).Methods A total of 82 patients with newly diagnosed nasopharyngeal carcinoma who were admitted to our hospital from January 2016 to December 2021 were selected and all underwent IMRT.DCE-MRI was performed before IMRT,and K^(trans),K_(ep),V_(e),and V_(p) were calculated.Three months after the end of IMRT,the patients were divided into good group(n=52)and poor group(n=30)according to the clinical efficacy.The DCE-MRI parameters before IMRT and clinical data in the good group and the poor group were compared.Logistic regression analysis was used to analyze the risk factors for poor prognosis of IMRT.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of DCE-MRI parameters for the prognosis of newly diagnosed nasopharyngeal carcinoma patients with IMRT.Results Compared with the good group,the K^(trans) and K_(ep) before IMRT in the poor group were significantly decreased,the proportion of anemia,the size of the primary tumor was superluminal,the T stage was T_(3) to T_(4),and the retropharyngeal lymph node metastasis were increased(P<0.05).Logistic regression analysis showed that anemia[OR=1.732(95%CI:1.269,2.194)],the size of primary tumor was superluminal[OR=1.489(95%CI:1.254,1.724)],retropharyngeal lymph node metastasis[OR=2.659(95%CI:2.013,3.305)],T_(3) or T_(4) stage[OR=3.504(95%CI:1.987,5.022)],low K^(trans)[OR=5.865(95%CI:3.145,8.585)],and low K_(ep)[OR=3.142(95%CI:2.412,3.873)]were risk factors for poor prognosis in newly diagnosed nasopharyngeal carcinoma patients with IMRT(P<0.05).The ROC results showed that the optimal cut-off point of K^(trans) for predicting poor prognosis in newly diagnosed nasopharyngeal carcinoma patients with IMRT was 0.22 min,the AUC for predicting poor prognosis was 0.728(95%CI:0.618,0.820),and the sensitivity was 80.00%(95%CI:0.754,0.846),the specificity was 82.69%(95%CI:0.792,0.862).The best cut-off point of K_(ep) for predicting poor prognosis in newly diagnosed nasopharyngeal carcinoma patients with IMRT was 0.71 min,and the AUC for predicting poor prognosis was 0.746(95%CI:0.637,0.835),the sensitivity was 76.67%(95%CI:0.698,0.836),and the specificity was 75.00%(95%CI:0.671,0.829);the combined AUC of the two predicted poor prognosis was 0.762(95%CI:0.655,0.849),the sensitivity was 76.67%(95%CI:0.712,0.821),and the specificity was 88.46%(95%CI:0.804,0.965).Conclusion K^(trans) and K_(ep) in DCE-MRI have certain predictive value for the prognosis of newly diagnosed nasopharyngeal carcinoma patients with IMRT,which can provide a basis for clinical individualized treatment and modification of treatment plan.