基线CT对晚期转移性胃癌患者预后预测价值的初步研究

Preliminary study on the prognostic value of baseline CT in patients with metastatic far-advanced gastric cancer

目的探讨基线CT对晚期转移性胃癌患者无进展生存期(PFS)和总生存期(OS)的预测价值。方法回顾性分析2019年1月至2020年5月上海瑞金医院85例伴有腹膜或肝脏转移的晚期胃癌患者的临床和影像学资料。收集患者临床因素,包括体力状况(PS)评分、病灶部位、肿瘤指标;收集影像学因素,包括原发灶最长径、最大截面积及CT值、病灶强化是否均匀、CT血管壁外侵犯评分(ctEMVI)、转移淋巴结最大短径、胃周淋巴结是否融合及坏死、有无融合的大块淋巴结、肝脏转移灶最大截面积及CT值、腹膜转移CT评分、腹膜转移结节最大直径。以Kaplan-Meier生存曲线和log-rank检验分析指标的组间预后差异。单因素和多因素Cox比例风险回归模型用于确定PFS和OS的独立风险因素。结果原发灶最大截面积、平扫CT值、延迟期CT值和延迟期CT比值高、低风险组患者的PFS生存曲线差异有统计学意义(P<0.05),原发灶最大截面积高、低风险组患者的PFS和OS生存曲线差异有统计学意义(P<0.05)。单因素分析中,原发灶最大截面积、平扫CT值、延迟期CT值、延迟期CT比值及转移淋巴结最大短径是PFS的风险因素(P<0.05);PS评分、CA724、原发灶最大截面积、肝脏转移灶最大截面积和腹膜转移CT评分是OS的风险因素(P<0.05)。多因素分析中,原发灶最大截面积、平扫CT值是晚期胃癌患者PFS的独立风险因素(HR=0.41、2.50,P=0.009、0.006);PS评分、CA724、腹膜转移CT评分是患者OS的独立风险因素(HR=46.78、6.26、92.92,P=0.026、0.009、0.007)。结论基线CT上原发灶大小、病灶CT值以及腹膜转移CT评分可作为单部位远处转移不可切除晚期胃癌患者生存的独立风险因素,基线CT对于晚期胃癌患者具有一定的生存预测价值。

Objective To investigate the prognosis value of baseline contrast-enhanced CT in predicting progression-free survival(PFS)and overall survival(OS)for clinically diagnosed as metastatic far-advanced gastric cancer patients.Methods Between January 2019 and May 2020,85 pathologically confirmed gastric adenocarcinoma patients with peritoneal or hepatic metastasis at Shanghai Ruijin Hospital with complete preoperative clinical,image and follow-up data were enrolled in this retrospective study.Clinical factors included performance status(PS)score,tumor location,and tumor serological indicators.Imaging factors included the longest diameter and maximum cross-sectional area of the tumor,CT value,enhancement uniformity,CT extramural venous invasion(ctEMVI),the largest short diameter of the metastatic lymph nodes,confluent lymph nodes,lymph nodes necrosis,fused bulk lymph nodes,the maximum cross-sectional area and CT value of the liver metastases,peritoneal metastasis score,longest diameter of nodules with peritoneal metastasis.Kaplan-Meier survival curve and log-rank test were used to analyze the prognostic differences between groups.Univariate and multivariate Cox proportional hazards regression models were used to identify independent risk factors for PFS and OS.Results There were significant differences in the maximum cross-sectional area of the tumor,non-contrast CT value,delayed-phase CT value,and delayed-phase CT ratio value between the high-and low-risk groups in PFS(P<0.05).There were significant differences between the high-and low-risk groups with the maximum cross-sectional area of the tumor in PFS and OS(P<0.05).In the univariate analysis,the maximum cross-sectional area of tumor,plain-scan CT value,delayed-phase CT value,delayed-phase CT ratio value and the largest short diameter of metastatic lymph nodes were risk factors for PFS(P<0.05).PS score,CA724,maximum cross-sectional area of the tumor,maximum cross-sectional area of liver metastases,and peritoneal metastasis score were shown as risk factors for OS(P<0.05).In the multivariate analysis,the maximum cross-sectional area of the tumor and non-contrast CT value were independent risk factors for PFS(HR=0.41,2.50,P<0.05,0.006).PS score,CA724 and peritoneal metastasis score were independent risk factors for OS(HR=46.78,6.26,92.92,P=0.026,0.009,0.007).Conclusions Tumor size,CT attenuations,and peritoneal metastasis score on baseline CT can be used as independent risk factors for survival in patients with far-advanced gastric cancer with peritoneal or hepatic metastasis.Baseline CT is potentially useful in prediction of the survival status for patients with metastatic far-advanced gastric cancer.