MSCT平扫加增强扫描联合糖类抗原199水平预测直肠癌的病理学分类的价值

Value of MSCT plain scan plus enhanced scan combined with carbohydrate antigen 199 level in predicting the pathological classification of rectal cancer

目的 探讨多层螺旋CT(MSCT)平扫加增强扫描联合糖类抗原199(CA199)预测直肠癌病理学分类的价值。方法 回顾性选取2018年1月至2022年12月在宣城市人民医院接受治疗的直肠癌患者60例,分析不同分化程度、T分期及N分期直肠癌CT值、CA199差异,同时分析MSCT联合CA199在预测直肠癌分化程度、T分期及N分期中的价值。结果 低分化直肠癌增强CT值为(72.28±8.02) HU,明显低于中高分化直肠癌[(84.50±7.99)HU],而CA199为(72.65±9.92) U/mL,明显高于中高分化直肠癌[(61.44±10.11)U/mL],差异均有统计学意义(P<0.05)。T3~T4期直肠癌CA199为(67.90±8.11)U/mL,明显高于T1~T2期直肠癌[(60.85±8.09) U/mL],N1~N2期直肠癌CA199为(71.73±9.40) U/mL,明显高于N0期直肠癌[(61.43±9.15)U/mL],差异均有统计学意义(P<0.05);不同T分期、N分期直肠癌平扫CT值、增强CT值比较,差异均无统计学意义(P>0.05)。增强CT值、CA199及联合预测低分化直肠癌的受试者操作特征(ROC)曲线下面积分别为0.848、0.752和0.820,具有较好的预测价值(P<0.05)。CA199预测T3~T4期直肠癌的ROC曲线下面积为0.660,截断值为64.65 U/mL,敏感性和特异性分别为62.50%和70.00%。CA199预测N1~N2期直肠癌的ROC曲线下面积为0.829,截断值为65.12 U/mL,敏感性和特异性分别为91.70%和75.00%。MSCT、MSCT联合CA199预测T3~T4期直肠癌的敏感性、特异性、阳性预测值和阴性预测值比较,差异均无统计学意义(P>0.05)。MSCT、MSCT联合CA199预测N1~N2期直肠癌的敏感性、特异性、阳性预测值和阴性预测值比较,差异均无统计学意义(P>0.05)。结论 MSCT联合CA199在预测不同分化程度直肠癌方面有一定应用价值,值得进一步研究。

Objective To evaluate the value of plain and enhanced multi-slice spiral CT(MSCT)combined with carbohydrate antigen 199(CA199)in predicting the pathological classification of rectal cancer.Methods Sixty patients with rectal cancer who were treated in Xuancheng People's Hospital from January 2018 to December 2022 were retrospectively selected,the differences of CT value and CA 199 of rectal cancer in different differentiation degrees,T stages and N stages were analyzed,and the value of MSCT combined with CA 199 in predicting the differentiation degrees,T stages and N stages of rectal cancer were analyzed.Results The enhanced CT value of poorly differentiated rectal cancer was(72.28±8.02)HU,which was significantly lower than that of moderately well differentiated rectal cancer[(84.50±7.99)HU],while CA 199 was(72.65±9.92)U/mL,which was significantly higher than that of moderately well differentiated rectal cancer[(61.44±10.11)U/mL],the differences were statistically significant(P<0.05).The CA 199 in T 3-T 4 stage rectal cancer was(67.90±8.11)U/mL,which was significantly higher than that in T 1-T 2 stage rectal cancer[(60.85±8.09)U/mL],the CA199 in N 1-N 2 stage rectal cancer was(71.73±9.40)U/mL,which was significantly higher than that in N 0 stage rectal cancer[(61.43±9.15)U/mL],the differences were statistically significant(P<0.05).There was no statistically significant difference between plain CT and enhanced CT in different T stage and N stage rectal cancer(P>0.05).The area under receiver operating characteristic(ROC)curve of enhanced CT value,CA199 and combined prediction of poorly differentiated rectal cancer was 0.848,0.752 and 0.820 respectively,good predictive value(P<0.05).The area under the ROC curve predicted by CA199 for T 3-T 4 rectal cancer was 0.660 and the cut-off value was 64.65 U/mL,with sensitivity and specificity of 62.50%and 70.00%,respectively.The area under the ROC curve predicted by CA199 for N 1~N 2 stage rectal cancer was 0.829,the cut-off value was 65.12 U/mL,and the sensitivity and specificity were 91.70%and 75.00%,respectively.There was no statistically significant differences in sensitivity,specificity,positive predictive value and negative predictive value between MSCT,MSCT and CA199 in predicting T 3-T 4 rectal cancer(P>0.05).There was no statistically significant differences in sensitivity,specificity,positive predictive value and negative predictive value between MSCT,MSCT and CA199 in predicting N1-N2 rectal cancer(P>0.05).Conclusion MSCT combined with CA199 has certain application value in predicting rectal cancer of different differentiation degrees,which is worthy of further study.