DCE-MRI与肿瘤标志物对直肠癌淋巴结转移的评估价值

The Value of DCE-MRI and Tumor Markers for the Assessment of Lymph Node Metastasis in Rectal Cancer

目的 探究动态增强磁共振成像(DCE-MRI)与肿瘤标志物对直肠癌淋巴结转移的评估价值。方法前瞻性选取2019年1月至2022年12月本院收治的经手术切除治疗的直肠癌的患者180例为研究对象。根据患者淋巴结转移情况将患者分为淋巴转移组46例与无淋巴结转移组134例,比较淋巴转移组与无淋巴结转移组DCE-MRI参数(K^(trans)、V_(e)、K_(ep))、肿瘤标志物水平(CEA、CA199)的差异。通过二元Logistic回归分析是否为淋巴结转移相关因素,并通过受试者工作特征曲线(receiver operator characteristic curve,ROC)评估DCE-MRI参数(K^(trans)、V_(e)、K_(ep))、肿瘤标志物水平(CEA、CA199)与联合数据评估淋巴结转移的价值。结果 淋巴转移组K^(trans)、V_(e)、K_(ep)均高于无淋巴结转移组(P<0.05)。淋巴转移组CEA、CA199平均高于无淋.巴结转移组(P<0.05)。二元Logistic回归分析显示,K^(trans)、V_(e)、 K_(ep)、CEA、CA199是淋巴结转移影响因素(P<0.05)。ROC分析显示,K^(trans)、V_(e)、K_(ep)、CEA、CA199评估淋巴结转移的AUC为0.762、0.813、0.808、0.763、0.754。DCE-MRI参数联合、肿瘤标志物联合、五项联合评估淋巴结转移的AUC分别为0.889、0.853、0.895。结论 DCE-MRI定量参数、CEA、CA199评估淋巴结转移具有较好价值,且联合检测评估淋巴结转移准确性更好,可为临床治疗提供依据。

Objective To investigate the value of dynamic enhanced magnetic resonance imaging(DCE-MRI) and tumor markers for the assessment of lymph node metastasis in rectal cancer.Methods Prospectively.180 patients with rectal cancer treated by surgical resection admitted to our hospital from January2019 to December 2022 were selected for the study.Patients were divided into lymphatic metastasis group and no lymphatic metastasis group according to their lymph node metastasis,46 and 134 cases each,and the differences in DCE-MRI parameters [transit constant(K^(trans))],rate constant(K_(ep)),volume fraction(V_(e)),tumor marker levels [serum carcinoembryonic antigen(CEA) and glycoantigen 199(CA199)] between lymphatic metastasis group and no lymph node metastasis group were compared.Factors associated with lymph node metastasis were analyzed by binary logistic regression;and the value of DCE-MRI parameters(K^(trans),V_(e),K_(ep)),tumor marker levels(CEA,CA199) with combined data was evaluated by su bject operating cha racteristic curve(ROC).Results K^(trans) V_(e),and K_(ep) were higher in the lymphatic metastasis group than in the group without lymph node metastasis(P<0.05).CEA and CA199 levels were higher in the lymphatic metastasis group than in the no lymph node metastasis group(P<0.05).Binary logistic regression analysis showed that K^(trans),V_(e),K_(ep),CEA,and CA199 were factors influencing lymph node metastasis(P<0.05).ROC analysis showed that the AUCs of K^(trans),V_(e),K_(ep),CEA,and CA199 for assessing lymph node metastasis were 0.762,0.813,0.808,0.763,and 0.754.the AUCs of combined DCE-MRI parameters,combined tumor markers,and combined five items to assess lymph node metastasis were 0.889,0.853,and 0.895,respectively.Conclusion The quantitative parameters of DCE-MRI,CEA and CA199 have good value in assessing lymph node metastasis,and the combined test has better accuracy in assessing lymph node metastasis,which can provide a basis for clinical treatment.