MR-DWI表观弥散系数在局部晚期宫颈癌患者放化疗疗效评估中的价值研究

Clinical value of MR-DWI ADC in assessing the curative effect of radiochemotherapy for patients with locally advanced cervical cancer

目的:探讨磁共振弥散加权成像(MR-DWI)表观弥散系数(ADC)在局部晚期宫颈癌患者放化疗疗效评估中的临床价值。方法:选取医院收治并进行放化疗的86例局部晚期宫颈癌患者,依据实体瘤疗效评价标准(RECIST)评价患者放化疗疗效,根据放化疗疗效将其分为治疗敏感组(48例)和不敏感组(38例)。所有患者在治疗前、治疗中行MR-DWI检查,测量并比较两组患者病灶治疗前、治疗中的ADC值。利用受试者工作特征(ROC)曲线下面积(AUC)评估两组患者治疗前、治疗中ADC值对局部晚期宫颈癌患者放化疗疗效的评估价值,应用多因素Logistic回归分析探讨局部晚期宫颈癌患者放化疗疗效的影响因素。结果:在86例局部晚期宫颈癌患者中,放化疗后的完全缓解(CR)、部分缓解(PR)、病情稳定(SD)和疾病进展(PD)分别为25例(占29.07%)、23例(占26.74%)、22例(占25.58%)和16例(占18.60%)。放化疗前,敏感组ADC值[(1.20±0.20)×10^(-3)mm^(2)/s]低于不敏感组[(1.43±0.26)×10^(-3)mm^(2)/s],差异有统计学意义(t=4.638,P<0.05);放化疗治疗中,敏感组ADC值[(1.69±0.36)×10^(-3)mm^(2)/s]高于不敏感组[(1.52±0.29)×10^(-3)mm^(2)/s],差异有统计学意义(t=2.365,P<0.05)。放化疗治疗前两组ADC值的AUC、灵敏度和特异度分别为76.8%、72.6%和68.9%,放化疗治疗中分别为75.4%、75.8%和69.4%。治疗前ADC值、治疗中ADC值及分化程度均为局部晚期宫颈癌患者疗效的影响因素(OR=3.80,OR=3.50,OR=2.52;P<0.05)。结论:MR-DWIADC可对局部晚期宫颈癌患者放化疗疗效进行评估,并且具有较高的AUC值、灵敏度和特异度,且可作为预测局部晚期宫颈癌患者疗效的有效指标,为临床治疗方案及时调整提供参考依据。

Objective:To explore the clinical value of magnetic resonance diffusion-weighted imaging(MR-DWI)apparent diffusion coefficient(ADC)in assessing the curative effect of radiochemotherapy for patients with locally advanced cervical cancer.Methods:A total of 86 patients with locally advanced cervical cancer who admitted to our hospital and underwent radiochemotherapy were selected as the research subjects.The curative effects of radiochemotherapy for patients were evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST).All patients were divided into treatment-sensitivity group(48 cases)and treatment-insensitivity group(38 cases)according to the curative effect of radiochemotherapy.All patients underwent MR-DWI examination before and during treatment,and the ADC values of them were measured and compared before and during treatment.The area under the curve(AUC)of receiver operating characteristic(ROC)curve were drawn to assess the assessment value of ADC values before and during treatment on the curative effect of radiochemotherapy for patients with locally advanced cervical cancer.The multivariate logistic regression analysis was used to explore the influence factors on the curative effect of radiochemotherapy for patients with locally advanced cervical cancer.Results:In 86 patients with locally advanced cervical cancer,the number of complete response(CR),partial response(PR),stable disease(SD)and disease progression(PD)were respectively 25 cases(29.07%),23 cases(26.74%),22 cases(25.58%)and 16 cases(18.60%)after radiochemotherapy.Before radiochemotherapy,the ADC value[(1.20±0.20)×10^(-3)mm^(2)/s]of the treatment-sensitivity group was significantly lower than that[(1.43±0.26)×10^(-3)mm^(2)/s]of the treatmentinsensitive group,and the difference of that between two groups was statistically significant(t=4.638,P<0.05).During the radiochemotherapy,the ADC value[(1.69±0.36)×10^(-3)mm^(2)/s]of the treatment-sensitivity group was significantly higher than that[(1.52±0.29)×10^(-3)mm^(2)/s]of the treatment-insensitivity group(t=2.365,P<0.05).The AUC value,sensitivity and specificity of ADC value were respectively 76.8%,72.6%and 68.9%before radiochemotherapy,and they were respectively 75.4%,75.8%and 69.4%during radiochemotherapy.Both ADC values before and during treatment were correlative factors of the curative effect of patients with locally advanced cervical cancer(OR=3.80,OR=3.50,OR=2.52,P<0.05).Conclusion:MR-DWI ADC can assess the curative effect of radiochemotherapy for patients with locally advanced cervical cancer,which has higher AUC value,sensitivity and specificity.It can be used as an effective indicator to predict the curative effect of radiochemotherapy for patients with locally advanced cervical cancer,and can provide reference basis for the timely adjustment of clinical treatment plan.