磁共振弥散加权成像表观扩散系数在中晚期子宫颈鳞状细胞癌放疗效果评估中的价值

Value of apparent diffusion coefficient of diffusion-weighted magnetic resonance imaging in evaluating the radiotherapy efficacy for advanced cervical squamous cell carcinoma

目的探讨中晚期子宫颈鳞状细胞癌患者放疗前磁共振弥散加权成像(DWI)检查的表观扩散系数(ADC)与临床病理特征及放疗效果的关系。方法回顾性分析南京市第二医院2019年9月至2022年3月收治的80例中晚期子宫颈癌患者临床资料,所有患者均接受了磁共振成像(MRI)DWI检查。分析不同临床病理特征的子宫鳞状细胞癌患者ADC值差异,根据放疗效果将患者分为有效组(完全缓解+部分缓解)和无效组(疾病稳定+疾病进展),比较两组ADC值;采用logistic回归模型分析影响中晚期子宫颈鳞状细胞癌患者放疗效果的因素。结果80例中晚期子宫颈鳞状细胞癌患者中,放疗后达完全缓解21例,部分缓解31例,疾病稳定25例,疾病进展3例;放疗有效组52例,无效组28例。放疗有效组放疗前ADC值高于无效组[(0.99±0.14)×10^(-3)mm^(2)/s比(0.76±0.20)×10^(-3)mm^(2)/s],差异具有统计学意义(t=6.01,P<0.001);放疗有效组放疗后ADC值也高于无效组[(1.43±0.25)×10^(3)mm^(2)/s比(1.11±0.23)×10^(-3)mm^(2)/s],差异具有统计学意义(t=5.61,P<0.001);有效组和无效组患者放疗后的ADC值均较放疗前升高(均P<0.05)。不同国际妇产科联盟(FIGO)分期、病理分化程度、病灶浸润深度、Ki-67表达患者以及是否发生淋巴结转移、是否发生远处转移患者的ADC值比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,FIGO分期≥Ⅲ期、低分化、淋巴结转移、淋巴血管浸润、发生远处转移、放疗前ADC值过低是中晚期子宫颈鳞状细胞癌患者放疗效果的独立危险因素(均P<0.05)。结论放疗前ADC值是中晚期子宫颈鳞状细胞癌患者放疗效果的影响因素,放疗前ADC值越低,患者放疗效果越差。

Objective To explore the correlation of apparent diffusion coefficient(ADC)of magnetic resonance diffusion weighted imaging(DWI)examination before radiotherapy in patients with advanced cervical squamous cell carcinoma with clinicopathological characteristics and radiotherapy efficacy.Methods The clinical data of 80 patients with advanced cervical cancer who were admitted to the Second Hospital of Nanjing from September 2019 to March 2022 were retrospectively analyzed.All patients underwent magnetic resonance imaging(MRI)DWI examination.The differences in ADC values among cervical squamous cell carcinoma patients with different clinicopathological characteristics were analyzed.The patients were divided into the effective group(complete remission+partial remission)and the ineffective group(stable disease+progressive disease)based on the radiotherapy effect,and the differences in ADC values between the two groups were compared.The logistic regression model was used to analyze the factors affecting the radiotherapy efficacy of patients with advanced cervical squamous cell carcinoma.Results Among 80 patients with advanced cervical squamous cell carcinoma,21 achieved complete remission,31 achieved partial remission,25 achieved stable disease,and 3 achieved progressive disease after radiotherapy;there were 52 cases in the effective group and 28 cases in the ineffective group.The ADC value of the effective group before radiotherapy was higher than that of the ineffective group[(0.99±0.14)×10^(-3)mm^(2)/s vs.(0.76±0.20)×10^(-3)mm^(2)/s],and the difference was statistically significant(t=6.01,P<0.001);after radiotherapy,the ADC value of the effective group was also higher than that of the ineffective group[(1.43±0.25)×10^(-3)mm^(2)/s vs.(1.11±0.23)×10^(-3)mm^(2)/s],and the difference was statistically significant(t=5.61,P<0.001);the ADC values of both the effective and ineffective groups increased after radiotherapy compared to before radiotherapy(both P<0.05).The ADC values of patients with different International Federation of Obstetrics and Gynecology(FIGO)stage,degree of pathological differentiation,depth of lesion infiltration,Ki-67 expression,lymph node metastasis,and distant metastasis were statistically significant(all P<0.05).The results of multivariate logistic regression analysis showed that≥FIGO stageⅢ,low differentiation,lymph node metastasis,lymphatic vessel infiltration,distant metastasis,and low ADC value before radiotherapy were independent risk factors for efficacy of radiotherapy in patients with advanced cervical squamous cell carcinoma(all P<0.05).Conclusions The ADC value before radiotherapy is a factor that affects the radiotherapy effect of patients with advanced cervical squamous cell carcinoma.The lower the ADC value before radiotherapy is,the worse the radiotherapy effect of patients will be.