基于临床及CT影像特征评估进展期胃腺癌新辅助化疗疗效

Evaluating the efficacy of neoadjuvant chemotherapy for advanced gastric adenocarcinoma based on clinical features and CT image features

目的 分析进展期胃腺癌患者临床及CT影像特征,评估新辅助化疗疗效。方法 基于术后病理肿瘤退缩分级评估新辅助化疗疗效,进展期胃腺癌患者60例分为有效组(28例)和无效组(32例),两组均行术前SOX新辅助化疗方案(奥沙利铂+替吉奥)治疗。分析两组临床特征和新辅助化疗前后CT影像特征,分析影响新辅助化疗疗效的因素,绘制ROC曲线分析评估新辅助化疗疗效的相关指标。结果 两组病理组织分化程度比较有统计学差异(P<0.01)。两组强化模式改变、厚度变化率和面积变化率(ΔS)及新辅助化疗前后动脉期和静脉期CT值变化率比较均有统计学差异(P<0.05)。组织分化和ΔS是新辅助化疗疗效的独立影响因素(P<0.05)。组织分化联合ΔS评估新辅助化疗疗效的ROC曲线的AUC大于单一指标(P<0.05),其评估新辅助化疗疗效的灵敏度和特异度分别为92.31%和81.41%。结论 组织分化和ΔS是新辅助化疗疗效的独立影响因素,二者联合评估新辅助化疗疗效的效能最优。

Objective To analyze the clinical and CT features of the patients with advanced gastric adenocarcinoma and evaluate the efficacy of neoadjuvant chemotherapy.Methods Based on postoperative pathological tumor regression grading to evaluate efficacy of neoadjuvant chemotherapy,sixty patients with advanced gastric adenocarcinoma were divided into effective group(28cases)and ineffective group(32cases).Both groups received preoperative SOX neoadjuvant chemotherapy(oxaliplatin plus tiggio).Clinical features and CT image features before and after neoadjuvant chemotherapy were analyzed in two groups,the factors for efficacy of neoadjuvant chemotherapy were analyzed,and ROC curve was drawn to analyze relevant indicators for evaluating the efficacy of neoadjuvant chemotherapy.Results There was a significant difference in differentiation degree between the two groups(P<0.01).There were significant differences in the enhancement mode change,thickness change rate and area change rate(ΔS)and CT value change rate in arterial and venous phases before and after neoadjuvant chemotherapy between the two groups(P<0.05).Tissue differentiation andΔS were the independent factors for the efficacy of neoadjuvant chemotherapy(P<0.05).Compared to single indicator,the AUC of ROC curve of tissue differentiation combined withΔS was greater with the sensitivity and specificity of 92.31%and 81.41%respectively(P<0.05).Conclusion Tissue differentiation andΔS are the independent factors for the efficacy of neoadjuvant chemotherapy.The value of evaluating the efficacy of neoadjuvant chemotherapy is the best when combined use of the two factors.