定量CT身体组分分析预测胃癌手术联合辅助化疗复发转移的研究

The Value of Quantitative CT Body Composition Analysis in Predict the Recurrence and Metastasis of Gastric Cancer Treated by Surgery and Adjuvant Chemotherapy

目的探讨手术辅以化疗治疗前后的定量CT(QCT)身体组分参数的变化在评估胃癌患者复发转移中的价值。方法回顾性分析78例经病理证实为胃癌的患者,记录患者的性别、年龄、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、最大瘤径、肿瘤分期、肿瘤病理类型等资料。所有患者均于治疗前后分别行QCT扫描,并测量前后两次QCT参数,包括L1、L2椎体骨密度(BMD)和L3椎体水平皮下脂肪面积(SFA)、内脏脂肪面积(VFA)、总脂肪面积(TFA)、椎旁肌肉面积(MA)。将QCT扫描时间间隔标准化为120天,计算治疗前后所有QCT参数的变化率。通过绘制受试者工作特征(ROC)曲线获得QCT参数预测胃癌患者治疗后复发转移的最佳截断值。用独立样本t检验、Mann-Whitney U检验及Fisher精确检验进行单因素分析,再对单因素分析有意义的参数进行多因素Logistics回归分析筛选影响胃癌患者术后复发转移的独立危险因素。结果治疗前后ΔBMD、ΔSFA、ΔVFA、ΔTFA、ΔTMA分别为-3.78%,-3.35%,-4.65%,-9.62%和-5.62%;单因素分析显示,ΔBMD、ΔSFA、ΔVFA、ΔTFA及ΔMA是胃癌复发转移的影响因素(P<0.05);多因素Logistics回归分析显示,ΔBMD、ΔMA是胃癌患者复发转移的独立危险因素(P<0.05)。结论ΔBMD、ΔMA与手术联合辅助化疗胃癌患者的复发转移有关,QCT身体组分分析在胃癌患者治疗后复发转移的评估中具有一定参考价值。

Objective To explore the value of quantitative CT(QCT)body composition parameters before and after surgery combined with chemotherapy in evaluating recurrence and metastasis of gastric cancer patients.Methods Retrospective analysis was performed on 78 patients with gastric cancer confirmed by pathology.The data of gender,age,carcinoembryonic antigen,carbohydrate antigen 199,maximum tumor diameter,tumor stage and pathological type were recorded.All patients received QCT scanning before and after treatment,and QCT parameters were measured twice before and after treatment,including bone mineral density(BMD)of L1 and L2 vertebrae,subcutaneous fat area(SFA),visceral fat area(VFA),total fat area(TFA)and paravertebral muscle area(MA)at L3 vertebral level.The change rate of QCT parameters were calculated after the QCT scan interval was standardized as 120 days.The best cut-off values of QCT parameters for predicting recurrence and metastasis of gastric cancer patients after treatment was obtained by drawing ROC curve.The independent sample t-test,Mann-Whitney U test and Fisher’s exact test were used for univariate analysis.For the factors with significant differences,multivariate logistics regression was conducted to determine the independent factors in predicting the recurrence and metastasis of gastric cancer patients after operation.ResultsΔBMD,ΔSFA,ΔVFA,ΔTFA,ΔMA were-3.78%,-3.35%,-4.65%,-9.62%and-5.62%,respectively.Univariate analysis showed thatΔBMD,ΔSFA,ΔVFA,ΔTFA andΔMA were the influencing factors for the recurrence and metastasis of gastric cancer(P<0.05).Multivariate logistics regression analysis showed thatΔBMD andΔMA were independent risk factors for the recurrence and metastasis of gastric cancer(P<0.05).ConclusionΔBMD andΔMA are related to the recurrence and metastasis of gastric cancer patients receiving surgery combined with adjuvant chemotherapy.QCT body composition analysis has certain reference value in evaluating the recurrence and metastasis of gastric cancer patients aftertreatment.