早期胃癌T分期CT标准的探讨

The discussion on CT standard for T staging in early gastric cancer

目的:探讨胃癌CT分期征象在诊断早期胃癌(EGC)中的价值。方法:回顾性分析经病理证实的154例ECG及154例进展期胃癌(AGC)患者的临床病理特征及术前增强CT图像。将P<0.05的影像征象纳入多元logistic回归分析,并计算敏感度、特异度、准确度、阳性预测值和阴性预测值。结果:EGC与AGC患者在年龄、肿瘤位置、肿瘤最大径、胃切除类型、pN分期、pTNM分期、淋巴管浸润、静脉浸润及神经浸润等方面的差异有统计学意义(P<0.05)。Logistic回归分析结果显示低密度带完整或破坏<50%征象是T1期胃癌的独立预测因素。以低密度带完整或破坏<50%征象诊断早期胃癌的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为72.7%、94.0%、91.8%、94.0%和83.7%。结论:低密度带完整或破坏<50%征象是T1期胃癌的独立预测因素,具有较高准确度、特异度,可用于判断胃癌侵犯胃壁的深度,同时结合多平面重建技术对于胃癌术前T分期的评估具有重要价值。

Objective:To investigate the diagnostic value of CT signs for staging early gastric cancer(EGC).Methods:The clinicopathological features and pre-operative contrast enhanced CT images of 154 patients with EGC and 154 patients with advanced gastric cancer(AGC)confirmed by pathology were analyzed retrospectively.Subsequently,parameters with P value<0.05 were included in multivariate logistic regression and the sensitivity,specificity,accuracy,negative predictive value,and positive predictive value were calculated.Results:For EGC and AGC patients,there were significant differences in age,tumor location,maximum tumor diameter,operation method,pN staging,pTNM staging,lymphovascular invasion,venous invasion,and perineural invasion.The result of multiple logistic regression analyses showed that the intact low-attenuation-strip or disruption of the low-density-stripe layer(less than 50%of the thickness)sign were independent predictors in T1 gastric cancer.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of intact low-attenuation-strip or disruption of the low-density-stripe layer(less than 50%of the thickness)sign in the diagnosis of EGC were 72.7%,94.0%,91.8%,94%,and 83.7%,respectively.Conclusion:The intact low-attenuation-strip or disruption of the low-density-stripe layer(less than 50%of the thickness)sign were independent predictors in T1 gastric cancer with high accuracy and specificity,which can be used to judge the depth of gastric cancer and has significant value in the T staging of the gastric cancers before surgery.Combined with multiplanar reformations(MPR)images,it was of great value for preoperative T-stage evaluation of gastric cancer.