基于多参数CT特征模型预测胃癌脉管浸润的价值

The Value of A Multiparameter CT Featuresbased model in Predicting Lymphovascular Invasion in Gastric Cancer

目的探讨基于CT特征模型诊断胃癌脉管浸润(LVI)的价值。方法收集284胃癌患者资料(男191例,女93例,年龄28-89岁)并将其分为LVI阳性组(112例)和阴性组(172例)。收集CT定量特征包括肿瘤大小、CT值(平扫、动脉期、静脉期)和定性特征包括位置、瘤内血管、TMN分期,同时计算肿瘤动/静脉期强化程度(动/静脉期CT值-平扫CT值)。采用t检验或卡方检验比较两组间CT特征的差异。采用多因素筛选LVI危险因素。利用受试者工作特征曲线评估模型的效能。结果瘤内血管、T分期、N分期、静脉期CT值和静脉期强化程度在LVI阳性组和阴性组间的差异具有统计学意义(P均<0.05)。多因素分析显示瘤内血管、T分期、N分期、静脉期CT值和静脉期强化程度是LVI危险因素。基于联合瘤内血管、T分期、N分期的定性模型诊断效能高于基于联合静脉期CT值和静脉期强化程度的定量模型(0.777 vs.0.576,P<0.001),并与基于所有参数联合模型的诊断效能相似(0.777 vs.0.787,P=0.250)。结论瘤内血管、T分期、N分期、静脉期CT值和静脉期强化程度与胃癌LVI相关,基于所有参数联合模型能够用于术前评估胃癌LVI。

Objective To explore the value of a CT features-based model in predicting lymphovascular invasion(LVI)in gastric cancer.Methods A retrospective analysis was conducted on 284 patients with gastric cancer,comprising of 191 male and 93 female patients with an age range of 28-89 years.The patients were divided into the LVI positive group(112 cases)and LVI negative group(172 cases).Quantitative CT features such as tumor size,CT attenuation value of tumor in noncontrast images,arterial and venous phase images,and qualitative CT features such as tumor location,intratumoral vessel,and TMN stage,were collected.The degree of enhancement tumors in arterial/venous phase(the CT value difference of tumors between arterial/venous phase and noncontrast images)was also calculated.The CT features between LVI positive group and LVI negative group were compared using the t test and chisquared test.The multivariate analysis was used to select the risk factors for LVI.A receiver operating characteristic curve was used to assess the diagnostic performance of the model.Results There were significant difference in the intratumoral vessel,T stage,N stage,CT value of tumor in the venous phase images,and the degree of enhancement in the venous phase between LVI positive group and LVI negative group(all P<0.05).Multivariate analysis showed that intratumoral vessel,T stage,N stage,CT value of tumors in the venous phase images,and the degree of enhancement in the venous phase were associated with LVI positivity.The qualitative features-based model,which combined intratumoral vessel,T stage,and N stage,showed a higher performance than the quantitative featuresbased model that incorporated the CT value of tumor in the venous phase images and the degree of enhancement in venous phase(0.777 vs.0.576,P<0.001).It also had similar diagnostic efficacy with the combined model that incorporated all CT features(0.777 vs.0.787,P=0.250).Conclusion The intratumoral vessel,T stage,N stage,CT value of tumor in the venous phase images,and the degree of enhancement in the venous phase were associated with LVI positivity.The combined model that incorporated all CT features can be used to predict LVI in gastric cancer.