基于磁共振灌注指标构建晚期鼻咽癌缓解效果预测模型的临床研究

Clinical study on the prediction model based on magnetic resonance perfusion index of remission effects of advanced nasopharyngeal carcinoma

目的探讨晚期鼻咽癌放化疗缓解效果独立影响因素,并基于磁共振灌注指标构建预测模型,旨在为后续临床诊疗方案优化及个体化应用提供更多参考。方法纳入2017年1月~2022年1月丽水市人民医院接受诱导化疗+同步放化疗治疗晚期鼻咽癌患者共150例,记录临床病理、磁共振检查及缓解效果等资料,采用单因素和多因素法评价晚期鼻咽癌放化疗缓解效果独立影响因素,基于上述独立影响因素构建列线图模型,描绘受试者工作特征(ROC)曲线分析该模型用于患者放化疗缓解效果预测临床效能。结果150例患者放化疗后缓解104例,未缓解46例。单因素分析结果显示,磁共振扫描证实肿瘤最大径、临床分期、病理组织学类型及磁共振动脉自旋标记(arterial spin labeling,ASL)序列扫描下肿瘤组织血流量均与晚期鼻咽癌放化疗缓解效果有关(P<0.05)。多因素分析结果显示,临床分期、病理组织学类型及磁共振ASL序列扫描下肿瘤组织血流量均是晚期鼻咽癌放化疗缓解效果独立影响因素(P<0.05)。基于临床分期、病理组织学类型及磁共振ASL序列扫描下肿瘤组织血流量构列线图模型C指数=0.90(95%CI:0.84~0.97),提示此模型具有良好区分度。ROC曲线分析结果显示,上述列线图模型用于晚期鼻咽癌放化疗缓解效果预测曲线下面积(AUC)为0.85(95%CI:0.81~0.93),灵敏度和特异度分别为81.05%和74.39%。结论晚期鼻咽癌放化疗缓解效果除受临床分期和病理组织学类型影响外,还与磁共振灌注指标关系密切,而基于上述指标构建列线图模型在晚期鼻咽癌放化疗缓解效果预测方面具有良好效能。

OBJECTIVE To investigate the independent influencing factor of remission effects of advanced nasopharyngeal carcinoma and construct the prediction model based on magnetic resonance perfusion index in order to provides more reference for the optimization and individualized application of follow-up clinical diagnosis and treatment plan.METHODS 150 patients with advanced nasopharyngeal carcinoma received induction chemotherapy+concurrent chemoradiotherapy were retrospectively chosen in the period from January 2017 to January 2022 in Lishui People's Hospital.The data of clinical pathology,magnetic resonance examination and remission effect were recorded.Univariate and multifactorial methods were used to evaluate the independent factors influencing of remission effects of in advanced nasopharyngeal carcinoma treated by radiotherapy combined with chemotherapy.Based on the above independent influencing factors,the line graph model was constructed and ROC curve was drawn to analyze the predictive efficacy of remission effects after radiotherapy combined with chemotherapy based on the model above.RESULTS Of the 150 patients,104 were relieved and 46 had no remission after radiotherapy combined with chemotherapy.Univariate analysis showed that the maximum tumor size,clinical stage,histopathological type and tumor tissue blood flow under MR-ASL sequence scanning were all correlated with the remission effects after radiotherapy combined with chemotherapy in advanced nasopharyngeal carcinoma(P<0.05).Multivariate analysis showed that clinical stage,histopathological type and tumor tissue blood flow under MR-ASL sequence scanning were independent influencing factors of remission effect after radiotherapy combined with chemotherapy in advanced nasopharyngeal carcinoma(P<0.05).The C-index of line diagram model based on clinical stage,histopathological type and tumor tissue blood flow under MRI ASL sequence scanning was 0.90(95%CI:0.84-0.97),suggesting that the model had good differentiation.ROC curve analysis results showed that the AUC of the line diagram model above for predicting the remission effects after radiotherapy combined with chemotherapy in patients with advanced nasopharyngeal carcinoma was 0.85(95%CI:0.81-0.93),and the sensitivity and specificity were 81.05%and 74.39%,respectively.CONCLUSION The remission effect after radiotherapy combined with chemotherapy in patients with advanced nasopharyngeal carcinoma was not only affected by clinical stage and histopathological type,but also closely related to MRI perfusion index and the line graph model construction based on the above indicators has good efficacy in predicting the remission effect after radiotherapy combined with chemotherapy.