计算机断层扫描多平面重建技术在食管癌放射治疗疗效评价中的应用价值

The application value of computed tomography multiplanar reconstruction in the evaluation of radiotherapy effect of esophageal cancer

目的 探讨计算机断层扫描(computed tomography,CT)多平面重建技术在食管癌放射治疗(以下简称放疗)疗效评价中的应用价值。方法 选择2018年1月至2022年10月安徽医科大学附属巢湖医院收治的89例食管癌患者为研究对象。所有患者先行CT多平面重建,再行根治性放疗(调强或适形放疗等),每周5次,共计6周。记录患者近期疗效。比较放疗前后淋巴结长径和短径、最大管壁厚度;比较不同疗效患者淋巴结长径和短径、最大管壁厚度;采用受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析淋巴结长径和短径对食管癌患者放疗近期疗效的预测价值;采用多因素Logistic回归分析探讨食管癌患者放疗近期疗效的危险因素。结果 食管癌患者放疗后淋巴结长径和短径均显著短于放疗前(均P <0.05),放疗后最大管壁厚度较放疗前无明显变化(P> 0.05)。放疗后有效患者淋巴结长径和短径均显著短于无效患者(均P <0.05)。不同疗效的患者最大管壁厚度比较差异无统计学意义(P> 0.05)。经ROC曲线分析,淋巴结长径预测食管癌患者放疗近期疗效的敏感度为76.91%,特异度为85.52%;淋巴结短径预测食管癌患者放疗近期疗效的敏感度为76.50%,特异度为84.21%。经多因素Logistic回归分析显示,临床分期、淋巴结长径和短径是食管癌患者放疗近期疗效的独立危险因素(均P <0.05)。结论 CT多平面重建技术后获得的多平面淋巴结形态学特征可作为食管癌放疗患者疗效评估的辅助参考指标。

Objective To explore the application value of computed tomography(CT)multiplanar reconstruction technology in the evaluation of radiotherapy effect of esophageal cancer.Method Eighty-nine patients with esophageal cancer admitted to Chaohu Hospital Affiliated to Anhui Medical University from January 2018 to October 2022 were selected as the research objects.All patients underwent CT multiplanar reconstruction followed by radical radiotherapy(intensity modulated or conformal radiotherapy,etc.)5 times a week for a total of 6 weeks.The short-term efficacy of patients was recorded.The long and short diameters of lymph nodes and the maximum esophageal wall thickness before and after radiotherapy were compared;the long and short diameter of lymph nodes and the maximum esophageal wall thickness in patients with different therapeutic effects were compared;the receiver operator characteristic curve(ROC curve)was used to analyze the predictive value of the long and short diameter of lymph nodes for the short-term efficacy of radiotherapy in esophageal cancer patients.Multivariate Logistic regression analysis was used to analyze risk factors affecting the short-term efficacy of radiotherapy in esophageal cancer patients.Result After radiotherapy,the long and short diameter of lymph nodes in esophageal cancer patients were significantly shorter than those before radiotherapy(all P<0.05),the maximum esophageal wall thickness compared to before radiotherapy had no significant change(P>0.05).The long and short diameters of lymph nodes in effective patients were significantly shorter than those in ineffective patients(all P<0.05).The maximum esophageal wall thickness between patients with different therapeutic effects had no significant difference(P>0.05).According to ROC curve analysis,the sensitivity and specificity of long diameter lymph nodes in predicting the short-term efficacy of radiotherapy were 76.91%and 85.52%,respectively;the sensitivity and specificity of short diameter lymph nodes in predicting the short-term efficacy of radiotherapy were 76.50%and 84.21%,respectively.Multivariate Logistic regression analysis showed that clinical stage,long and short diameter of lymph nodes were independent risk factors affecting the short-term efficacy of radiotherapy(all P<0.05).Conclusion The morphological characteristics of multiplanar lymph nodes obtained by CT multiplanar reconstruction technique can be used as an auxiliary reference index for evaluating the efficacy of radiotherapy in patients with esophageal cancer.