CT对于进展期胃癌新辅助化疗疗效的预测价值

Predictive value of CT for neoadjuvant chemotherapy in advanced gastric cancer

目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)三维图像评价进展期胃癌新辅助化疗疗效的价值。方法将2019年1月至2022年3月期间于兰州大学第一医院经胃镜及病理学检查确诊的61例胃癌患者,按照术后病理学退缩分级标准(tumor regression grade,TRG)分为化疗有效组(n=39)和无效组(n=22),在新辅助化疗前和新辅助化疗后手术治疗前行MSCT检查,通过二元logistics回归分析CT常规临床指标(包括肿瘤最大厚度、胃壁蠕动性、强化方式、淋巴结转移、远处转移以及腹膜增厚或腹膜结节)筛选与化疗疗效有关的独立预测因素。用影像组学软件ITK-snap测算肿瘤体积及肿瘤最大厚度,分析肿瘤体积与CT常规临床指标的诊断效能。结果在化疗疗效评价方面,肿瘤体积减小率与肿瘤最大厚度减小率均可以在一定程度上评价化疗后疗效(P<0.01)。对于肿瘤CT临床观察指标进行单因素分析并将具有统计学意义的指标(肿瘤最大厚度减小率、胃壁蠕动性、病变强化方式及腹膜增厚与结节)进行二元logistic回归分析,其结果显示胃壁蠕动性[OR=0.294,95%CI为(0.093,0.928),P=0.037]和肿瘤最大厚度减小率[OR=0.282,95%CI为(0.083,0.957),P=0.042]是进展期胃癌新辅助化疗疗效的独立预测指标,将二者得出的预测概率变量和肿瘤体积减小率绘制受试者工作特征(receiver operating characteristic,ROC)曲线,其结果显示:肿瘤体积减小率的ROC曲线下面积(area under curve,AUC)为0.900、敏感度为83.3%、特异度为99.8%,均高于CT临床指标预测概率变量(AUC=0.802,敏感度为58.3%,特异度为85.7%)。结论MSCT结合影像组学软件ITK-snap测算肿瘤体积对于新辅助化疗疗效的预测提供了客观依据,其诊断效能较好。

Objective To explore the value of multi-slice spiral CT(MSCT)3D imaging in evaluating the efficacy of neoadjuvant chemotherapy for advanced gastric cancer.Methods Sixty-one patients with gastric cancer diagnosed by gastroscopy and pathological examination at the First Hospital of Lanzhou University from January 2019 to March 2022 were divided into chemotherapy effective group(n=39)and ineffective group(n=22)according to postoperative pathological regression grade(tumor regression grade,TRG)standards.MSCT was performed before neoadjuvant chemotherapy and before undergoing surgical treatment after neoadjuvant chemotherapy.The independent predictors related to the efficacy of chemotherapy were screened by binary logistics regression analysis of CT conventional observation indexes(including maximum tumor thickness,gastric wall motility,enhancement mode,lymph node metastasis,distant metastasis,peritoneal thickening or peritoneal nodules).Tumor volume and maximum tumor thickness were measured with the imaging histology software ITK-snap,and the diagnostic efficacy of tumor volume and CT conventional observation indexes was analyzed.Results In the evaluation of chemotherapy efficacy,tumor volume reduction rate and tumor maximum thickness reduction rate can evaluate the efficacy of chemotherapy to a certain extent(P<0.01).The statistically significant indicators(tumor maximum thickness reduction rate,gastric wall motility,lesion intensification mode and peritoneal thickening and nodules)were analyzed by univariate analysis and binary logistic regression.The results showed that gastric wall motility[OR=0.294,95%CI(0.093,0.928),P=0.037]and maximum tumor thickness reduction rate[OR=0.282,95%CI(0.083,0.957),P=0.042]were independent predictors of the efficacy of neoadjuvant chemotherapy for progressive gastric cancer.Receiver operating characteristic(ROC)curve were plotted based on the predicted probability variable obtained from both and the results showed that the area under curve(AUC=0.900),sensitivity(83.3%),and specificity(99.8%)of the tumor volume reduction rate were all higher than those of CT clinical index prediction probability variables(AUC=0.802,sensitivity was 58.3%,specificity was 85.7%).Conclusion The measurement of tumor volume by MSCT combined with the imaging omics software ITK-snap provides an objective basis for the prediction of the efficacy of neoadjuvant chemotherapy,and its diagnostic efficacy is better.