术前磁共振成像的三维评估在cN0期舌鳞癌患者颈淋巴结转移及预后中的预测价值

Three⁃dimensional assessment of cN0 tongue squamous cell carcinoma by preoperative MRI for predicting metastasis of cervi⁃cal lymph node and prognosis

目的:通过磁共振成像(MRI)测量cN0期患者舌部病灶的浸润深度及肿瘤体积,探索其在患者颈淋巴结转移及预后中的预测价值。方法:收集术前完善口咽MRI检查的cN0期舌鳞癌患者74例,通过IKT⁃SNAP和3D slicer软件重建舌部病灶并测量其浸润深度及肿瘤体积;通过R语言绘制浸润深度、肿瘤体积与颈淋巴转移之间的受试者工作特征曲线(ROC)曲线并确定临界值;对临床参数与颈淋巴转移的相关性进行Logistic回归分析,并通过单因素及多因素COX回归分析影响cN0期舌鳞癌患者预后的独立危险因素。结果:6.3 cm^(3)的肿瘤体积和14 mm的肿瘤浸润深度可作为临界值来预测颈淋巴结的转移;多因素回归分析表明MRI测量得到的浸润深度可作为影响舌鳞癌患者颈淋巴结转移和预后的独立危险因素(P<0.05);Kaplan⁃Meier分析表明浸润深度≥14 mm的患者有着更差的预后(P<0.05)。结论:MRI测得的浸润深度可作为预测cN0期舌鳞癌患者颈淋巴结转移和预后的独立指标,而肿瘤体积则没有这样的预测作用。

Objective:Measuring the depth of invasion and tumor volume of tongue lesions in patients with cN0 stage by preopera⁃tive MRI,and further exploring the predictive value of depth of invasion and tumor volume in cervical lymph node metastasis and prog⁃nosis.Methods:74 patients clinically diagnosed as cN0 stage tongue squamous cell carcinoma who completed preoperative oropharyn⁃geal MRI examination were collected.The tongue lesions were reconstructed,then the depth of invasion and volume were measured by IKT⁃SNAP and 3D slicer software.The ROC curve between the depth of invasion,tumor volume and cervical lymph node metastasis was drawn by R language,and the cutoff value was determined.The correlation between clinical parameters and cervical lymph node metas⁃tasis was analyzed by logistic regression,and the independent risk factors affecting the prognosis of patients were analyzed by univariate and multivariate COX regression.Results:Tumor volume of 6.3 cm^(3) and invasive depth of 14 mm could be used as cutoff values to pre⁃dict lymph node metastasis;multivariate analyses revealed that the depth of invasion based on preoperative MRI could be used as an in⁃dependent risk factor for cervical lymph node metastasis and prognosis of oral cancer(P<0.05);Kaplan⁃Meier analysis showed that pa⁃tients with invasive depth≥14 mm had a poor prognosis(P<0.05).Conclusions:Depth of invasion measured by MRI can serve as an independent indicator for predicting cervical lymph node metastasis and prognosis in cN0 stage tongue squamous cell carcinoma pa⁃tients,while tumor volume does not have such a predictive effect.