能谱CT定量参数预测非小细胞肺癌PD-L1表达的价值

The value of quantitative parameters of spectral CT in predicting PD-L1 expression in non-small cell lung cancer

目的:探讨能谱CT定量参数预测非小细胞肺癌程序性死亡配体1(PD-L1)表达的价值。方法:分析68例经病理证实的非小细胞肺癌患者,根据PD-L1表达情况分为阳性组与阴性组,收集两组能谱CT特征和定量参数。能谱CT定量参数包括40 keV及70 keV单能量CT值(CT40keV、CT70keV)、碘浓度(IC)、标准碘浓度(NIC)、能谱曲线斜率(λHU)。分析PD-L1表达与能谱CT定量参数、临床及CT特征的相关性,并建立Logistic回归模型。结果:PD-L1阳性组与阴性组在性别、吸烟史、病理类型、肿瘤直径、空泡征、GGO、CTA_(70keV)值、CTV_(70keV)值之间差异有统计学意义。受试者工作特征曲线(ROC)显示CTA_(70keV)值的曲线下面积(AUC)较大,其AUC为0.683,敏感度为68.60%,特异度为72.70%。多因素Logistic回归分析显示空泡征(P=0.029)、GGO(P=0.003)、CTA_(70keV)值(P=0.028)是PD-L1表达的独立预测因素,其回归模型的AUC为0.868,敏感度为71.40%,特异度为81.80%。结论:能谱CT定量参数CTA_(70keV)值在预测非小细胞肺癌患者PD-L1表达中有一定的价值。

Objective:To explore the value of quantitative parameters of spectral CT in predicting programmed death ligand-1(PD-L1)expression in non-small cell lung cancer.Methods:Sixty-eight cases of non-small cell lung cancer confirmed by pathology were analyzed.According to the expression of PD-L1,they were divided into positive group and negative group.The spectral CT features and quantitative parameters of the two groups were collected.Spectral CT quantitative parameters in-clude enhanced monochromatic CT number of 40 keV and 70 keV(CT_(40keV),CT_(70keV)),iodine concentration(IC),normalized iodine concentration(NIC),slope of the spectral curve(λ_(HU)).The correlation between PD-L1 expression and spectral CT quantitative parameters,clinical and CT features was explored,and a Logistic regression model was constructed.Results:There were significant differences in gender,smoking history,pathological type,tumor diameter,cavitation,GGO,CTA_(70keV)value and CTV_(70keV)value between positive PD-L1 expression group and negative PD-L1 expression group.The receiver operating curve(ROC)showed that the area under the curve(AUC)of CTA_(70keV)value was larger,with an AUC of 0.683,a sensitivity of 68.60%and a specificity of 72.70%.Multivariate Logistic regression analysis showed that cavitation(P=0.029),GGO(P=0.003)and CTA_(70keV)value(P=0.028)were independent predictors of PD-L1 expression,and the AUC of the regression model was 0.868,the sensitivity was 71.40%and the specificity was 81.80%.Conclusion:The CTA_(70keV)value of spectral CT quantitative parameter has a certain value in predicting PD-L1 expression in patients with non-small cell lung cancer.