表观扩散系数在术前预测子宫内膜癌肌层浸润、Ki-67和P53表达水平的临床价值

The value of the apparent diffusion coefficient in preoperative prediction of myometrial infiltration,Ki-67 and P53 expression levels in endometrial carcinoma

目的探讨表观扩散系数(apparent diffusion coefficient,ADC)值在术前无创性预测子宫内膜癌(endometrial carcinoma,EC)患者子宫肌层浸润(myometrial infiltration,MI)、Ki-67和P53表达水平的可行性。材料与方法回顾性分析兰州大学第二医院2017年1月至2021年12月期间在术前接受MRI扩散加权成像(diffusion weighted imaging,DWI)检查并在术后经病理证实的105名EC患者临床资料和影像数据,两名独立的放射科医生分别对照MRI增强和DWI图像在ADC图像上测量EC的最大ADC值(ADCmax)、平均ADC值(ADCmean)及最小ADC值(ADCmin)。采用二元logistic回归筛选EC患者的临床信息、ADC值与MI、Ki-67和P53表达的相关性,构建列线图预测模型,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线和临床决策曲线(decision curve analysis,DCA)对预测模型进行评价。结果ADCmax、ADCmean和ADCmin与EC患者MI、Ki-67和P53表达水平显著相关(P<0.05),而国际妇产科学联合会(the International Federation of Gynecology and Obstetrics,FIGO)分期仅与EC患者MI和Ki-67表达水平显著相关(P<0.05)。将ADCmax、ADCmean、ADCmin与FIGO分期结合起来构建列线图模型,预测模型、ADCmax、ADCmean、ADCmin和FIGO分期预测MI的ROC曲线下面积(area under the curve,AUC)值分别为0.809、0.707、0.693、0.694和0.599;预测Ki-67表达水平的AUC值分别为0.897、0.879、0.849、0.808和0.550。结合ADCmax、ADCmean、ADCmin构建列线图模型,预测模型、ADCmax、ADCmean和ADCmin预测P53表达水平的AUC值分别为0.665、0.615、0.641和0.654。结论基于ADC值联合FIGO分期构建的列线图预测模型可作为一种有效方法在术前无创性评估EC患者MI、Ki-67和P53表达。

Objective:To investigate the feasibility of the apparent diffusion coefficient(ADC)in the preoperative noninvasive prediction of myometrial infiltration,Ki-67 and P53 expression levels in patients with endometrial cancer(EC).Materials and Methods:Retrospective analysis of 105 patients with EC who underwent preoperative MRI diffusion weighted imaging(DWI)and were confirmed by pathology after operation from January 2017 to December 2021 in the Second Hospital of Lanzhou University.Two independent radiologists measured the ADC value(ADCmax,ADCmean and ADCmin)of EC on the ADC image by comparing MRI enhancement and DWI images respectively.Statistical methods were used to calculate the correlation between clinical information,ADC values and myometrial infiltration,Ki-67 and P53 expression in EC patients.A nomogram prediction model was constructed and the constructed prediction model was evaluated by plotting the receiver operating characteristic(ROC)curve,calibration curve analysis and decision curve analysis(DCA).Results:ADCmax,ADCmean and ADCmin were significantly correlated with myometrial infiltration,Ki-67 and P53 expression levels in EC patients(P<0.05).The International Federation of Gynecology and Obstetrics(FIGO)stage was only significantly associated with myometrial infiltration and Ki-67 expression levels in EC patients(P<0.05).The ADCmax,ADCmean and ADCmin were combined with FIGO stage to construct the nomogram model.The nomogram model,ADCmax,ADCmean,ADCmin and FIGO stage predicted area under the curve(AUC)values of 0.809,0.707,0.693,0.694 and 0.599 for myometrial infiltration,respectively.The AUC values for predicting Ki-67 expression levels were 0.897,0.879,0.849,0.808 and 0.550,respectively.The nomogram model was constructed by combining ADCmax,ADCmean and ADCmin.The AUC values predicted P53 expression levels by the nomogram,ADCmax,ADCmean and ADCmin were 0.665,0.615,0.641 and 0.654,respectively.Conclusions:The nomogram prediction model based on ADC values combined with FIGO stage can be used as a useful method for the preoperative non-invasive assessment of myometrial infiltration,Ki-67 and P53 expression in EC patients.