基于MRI观察壁外血管侵犯情况对直肠癌新辅助放化疗后根治性手术患者预后的预测价值

The Predictive Value of Observing Extramural Vascular Invasion based on MRI for the Prognosis of Rectal Cancer Patients Undergoing Radical Surgery after Neoajuvant Chemoradiotherapy

目的:探讨基于MRI观察壁外血管侵犯(mrEMVI)情况对直肠癌新辅助放化疗(NCRT)后根治性手术患者预后的预测价值。方法:回顾性收集2019年1月至2020年12月于我院行NCRT后接受根治性手术的56例直肠癌患者资料,所有患者均于NCRT前接受MRI检查,根据检查所示壁外血管侵犯情况分为mrEMVI阳性组和mrEMVI阴性组,分析2组临床病理资料差异;根据术后2年随访情况分为预后不良组(死亡、复发、转移)和预后良好组,分析2组mrEMVI及临床病理资料差异;Logistic回顾分析影响患者预后的因素;建立受试者工作(ROC)曲线评估mrEMVI对预后的预测价值。结果:与mrEMVI阴性组相比,mrEMVI阳性组T3~4期、中高分化、浸润深度>20 mm、肿瘤下缘距肛门的距离<50 mm者比例更高,P<0.05。与预后良好组相比,预后不良组患者>55岁、T3~4期、中高分化、浸润长度>50 mm、浸润深度>20 mm、肿瘤下缘距肛门的距离<50 mm、mrEMVI阳性者比例更高,P<0.05。Logistic回归分析显示,年龄、肿瘤分期、分化程度、浸润长度、浸润深度、肿瘤下缘距肛门的距离、mrEMVI是患者预后不良的影响因素(P<0.05)。ROC曲线结果显示,mrEMVI患者预后不良曲线下面积为0.791,敏感度为0.688,特异度为0.750,约登指数为0.438。结论:mrEMVI与直肠癌患者病理参数存在一定联系,其对预测NCRT后根治性手术患者预后有一定价值。

Objective To explore the predictive value of observing extramural vascular invasion(EMVI)based on MRI(mrEMVI)for the prognosis of rectal cancer patients undergoing radical surgery after neoajuvant chemoradiotherapy(NCRT).Methods Retrospectively collected of data from 56 rectal cancer patients who underwent radical surgery after undergoing NCRT in author's hospital from January 2019 to December 2020.All patients underwent MRI examination before NCRT and were divided into mrEMVI positive group and mrEMVI negative group based on EMVI shown on the examination,the differences in clinical and pathological data between the two groups were analyzed;According to the 2-year follow-up after surgery,the patients were divided into poor prognosis group(death,recurrence,metastasis)and good prognosis group,the differences in mrEMVI and clinical pathological data between the two groups were analyzed;Analyzed the factors affecting patient prognosis by Logistic retrospective analysis;Established the receiver operating curve(ROC)to evaluate the predictive value of mrEMVI for prognosis.Results Compared with the mrEMVI negative group,the mrEMVI positive group had the higher proportion of T3~4 stage,medium to high differentiation,infiltration depth>20 mm,and distance from the lower edge of the tumor to the anus<50 mm,P<0.05.Compared with the good prognosis group,the proportion of patients with poor prognosis>55 years old,T3~4 stage,medium to high differentiation,infiltra-tion length>50 mm,infiltration depth>20 mm,distance from the lower edge of the tumor to the anus<50 mm,and positive mrEMVI were all higher in the poor prognosis group,P<0.05.Logistic regression analysis showed that age,tumor stage,degree of differentiation,infiltration length,infiltration depth,distance from the lower edge of the tumor to the anus,and mrEMVI were influencing factors for poor prognosis of patients(P<0.05).The ROC curve results showed that the area under the poor prognosis curve of mrEMVI patients was 0.791,the sensitivity was 0.688,the specificity was 0.750,and the Jordan index was 0.438C.onclusion There is a certain correlation between mrEMVI and pathological parameters in rectal cancer patients,which has certain value in predicting the prognosis of patients undergoing radical surgery after NCRT.