IVIM-DWI联合血清Apo-1/Fas评估鼻咽癌患者诱导化疗+同步放化疗近期疗效的价值

Value of ivim-dwi combined with serum Apo-1/Fas in evaluating the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma.

目的研究体素内不相干运动弥散成像(IVIM-DWI)检查联合血清Apo-1/Fas评估鼻咽癌患者诱导化疗+同步放化疗近期疗效的价值。方法回顾性纳入2019年1月至2022年1月青岛市城阳区人民医院收治的92例行诱导化疗+同步放化疗的鼻咽癌患者为研究对象。所有患者均于治疗前及治疗第21天、治疗结束后1个月行IVIM-DWI检查及血清Apo-1/Fas检查。根据治疗疗效将完全缓解和部分缓解患者归为有效组,无变化和疾病进展患者归为非有效组。分析患者不同治疗时点IVIM-DWI检查参数[参数表观扩散系数(ADC)、真实扩散系数(D)、灌注分数(f)]和血清Apo-1/Fas水平变化,并比较两组治疗后1个月上述指标差异,采用ROC曲线分析IVIM-DWI检查参数和血清Apo-1/Fas单一及联合评估鼻咽癌患者诱导化疗+同步放化疗近期疗效的价值。结果两组年龄、性别、体质量指数、病理类型、临床分期比较,差异均无统计学意义(P>0.05)。治疗前、治疗第21天、治疗后1个月ADC、D、f及血清Apo-1/Fas水平存在显著差异(P<0.05),其中参数ADC、D变化趋势为治疗前<治疗第21天<治疗后1个月;f变化趋势变现为先增高后降低,治疗前<治疗后1个月<治疗第21天;Apo-1/Fas变化趋势为治疗前>治疗第21天>治疗后1个月(P<0.05)。有效组ADC、D水平显著高于非有效组,Apo-1/Fas水平显著低于非有效组,差异均有统计学意义(P<0.05);两组f水平比较,差异无统计学意义(P>0.05)。经ROC曲线处理,结果显示ADC、D及Apo-1/Fas水平对鼻咽癌患者诱导化疗+同步放化疗近期疗效均有一定评估价值,曲线下面积分别为0.833、0.763、0.831;ADC、D及血清Apo-1/Fas联合评估鼻咽癌患者诱导化疗+同步放化疗近期疗效的敏感度为0.919、特异度0.833、准确率0.891、kappa值0.753。结论IVIM-DWI联合血清Apo-1/Fas水平对评估鼻咽癌患者诱导化疗+同步放化疗的近期疗效具有较好的临床应用价值。

Objective To study the value of intravesical incoherent motion diffusion imaging(IVIM-DWI)combined with serum Apo-1/Fas in evaluating the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma.Methods A total of 92 patients with nasopharyngeal carcinoma treated in Qingdao Chengyang District People's Hospital from January 2019to January 2022 were retrospectively included as the research object.All patients underwent IVIM-DWI and serum Apo-1/Fas examination before treatment,on the 21st day of treatment and 1 month after treatment.According to the therapeutic effect,patients with complete remission(CR)and partial remission(PR)were classified as effective group,and patients with no change(SD)and disease progression(PD)were classified as non effective group.The changes of ivim-dwi parameters[parameters apparent diffusion coefficient(ADC),true diffusion coefficient(d),perfusion fraction(f)]and serum Apo-1/Fas level at different treatment time points were analyzed,and compare the differences of the above indexes between the two groups one month after treatment.The value of ivim-dwi parameters and serum Apo-1/Fas single and combined evaluation of the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma was analyzed by ROC curve.Results There was no statistically significant difference in age,sex,body mass index,pathological type and clinical stage between the two groups(P>0.05).There were statistically significant differences in ADC,D,F and serum Apo-1/Fas levels before treatment,on the 21st day of treatment and 1 month after treatment(P<0.05).The change trend of F was first increased and then decreased,before treatment<1 month after treatment<on the 21st day of treatment.The change trend of Apo-1/Fas was before treatment>n the 21st day of treatment>1 month after treatment(P<0.05).The levels of ADC and D in the effective group were significantly higher than those in the non effective group,and the levels of Apo-1/Fas were significantly lower than those in the non effective group,the differences were statistically significant(P<0.05).There was no statistically significant difference in f level between the two groups(P>0.05).The ROC curve showed that the levels of ADC,D and Apo-1/Fas had certain evaluation value for the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma,and the areas under the curve were 0.833,0.763 and 0.831 respectively;The sensitivity of ADC,D and serum Apo-1/Fas in evaluating the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma was 0.919,the specificity was 0.833,the accuracy was 0.891 and the kappa value was 0.753.Conclusion Ivim-dwi combined with serum Apo-1/Fas level has good clinical value in evaluating the short-term efficacy of induction chemotherapy+concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma.