结肠癌发生肿瘤沉积的CT诊断及与患者预后结局的关系研究

CT diagnosis of tumor deposition in colon cancer and its relationship with prognosis

目的探讨结肠癌发生肿瘤沉积的多层螺旋CT(MSCT)参数特征及与患者预后结局的相关性。方法选取东营市人民医院2017年2月—2019年12月102例经病理学诊断为结肠癌的患者。其中,66例患者发现结肠癌癌旁肿瘤沉积84枚、经病理学检查发现55例患者肿瘤淋巴结转移67枚。所有患者术前接受MSCT检查;比较肿瘤沉积及淋巴结转移的MSCT影像学特征和MSCT参数。根据患者3年随访结局将患者分为死亡组和存活组,比较两组患者的临床资料,采用多因素一般Logistic回归模型分析患者不良预后结局的影响因素。结果结肠癌患者的肿瘤沉积与转移淋巴结的结节直径比较,差异无统计学意义(P>0.05);结肠癌患者的肿瘤沉积结节的边缘特征模糊、有毛刺征、有结节内部坏死占比均高于转移淋巴结(P<0.05);结肠癌患者的肿瘤沉积结节纵横径比值小于转移淋巴结(P<0.05);结肠癌患者的肿瘤沉积结节的平扫CT值、动脉期强化CT值、静脉期强化CT值均高于转移淋巴结(P<0.05);多因素一般Logistic回归模型分析结果显示,肿瘤呈低分化OR是结肠癌患者不良预后结局的独立危险因素(P<0.05)。结论MSCT的影像学特征及参数对临床鉴别结肠癌癌旁肿瘤沉积及转移淋巴结有重要价值,结肠癌癌旁肿瘤沉积与患者不良预后结局有一定的关系。

Objective To investigate the characteristics of multislice spiral CT(MSCT)parameters of tumor deposition in colon cancer and its correlation with the prognosis of patients.Methods From February 2017 to December 2019,102 patients with colon cancer confirmed by pathological examination in Our Hospital were selected for clinical study.Among them,66 patients found 84 tumor deposition near colon cancer,and 55 patients found 67 tumor lymph nodes metastasis by pathological examination.All patients received multi-slice spiral CT(MSCT)examination before surgery,and the MSCT parameters and imaging characteristics of tumor deposition and metastatic lymph nodes were compared;the patients were divided into death group and survival group according to the 3-year follow-up results.The relationship between tumor deposition and the prognosis of patients was analyzed by single factor and multi factor methods.Results There was no statistically significant difference in the diameter of tumor deposition nodules between colon cancer patients and metastatic lymph nodes(P>0.05);the proportion of blurred appearance,hairpin sign,and internal necrosis of tumor deposition nodules was higher than that of metastatic lymph nodes in the metastatic lymph node group(P<0.05);the aspect ratio of tumor deposition nodules in colon cancer patients was smaller than that of metastatic lymph nodes(P<0.05);the plain scan CT values,arterial phase enhanced CT values,and venous phase enhanced CT values of tumor deposition nodules in colon cancer patients were higher than those of metastatic lymph nodes(P<0.05);the results of the Logistic regression model showed that the poorly differentiated state of the tumor[OR=1.642(95%CI:1.024,2.634)],the occurrence of lymph node metastasis[OR=1.652(95%CI:1.063,2.568)],and the presence of tumor adjacent deposits[OR=1.745(95%CI:1.090,2.794)]were independent risk factors for poor prognosis in colon cancer patients(P<0.05).Conclusion According to the imaging characteristics and scanning parameters of MSCT,it is of great value in clinical differentiation of tumor deposits and metastatic lymph nodes adjacent to colon cancer.Tumor deposits adjacent to colon cancer have a certain relationship with the poor prognosis of patients.