螺旋CT联合血清纤维蛋白原检测在局部晚期非小细胞肺癌同步放化疗预后的预测效能

Predictive efficacy of spiral CT combined with serum Fbg detection in the prognosis of locally advanced NSCLC patients undergoing concurrent radiotherapy and chemotherapy

目的:探讨螺旋CT联合血清纤维蛋白原检测在局部晚期非小细胞肺癌(NSCLC)同步放化疗预后的预测效能。方法:选取2018年4月至2023年1月中国科学院合肥肿瘤医院收治的60例局部晚期非小细胞肺癌患者,均给予同步放化疗,依据预后将其分为存活组(50例)和终点事件组(10例),两组患者治疗前均经螺旋CT检查,统计CT相关指标中平均CT值、噪声、信噪比(SNR)。检测两组治疗前血清纤维蛋白原(Fbg)水平,随访至2023年10月,统计9个月内的随访时间。采用Kaplan-Meier法和Logrank分析预后情况。采用二元回归分析纳入平均CT值、噪声、SNR及Fbg的实际数据,并进行受试者工作特性(ROC)曲线分析,获得各指标单独及联合预测预后的效能值。结果:终点事件组平均CT值、噪声明显高于存活组,SNR明显低于存活组,血清Fbg水平明显高于存活组,差异均有统计学意义(t=5.445、18.323、7.580、78.628,P<0.05);平均CT值、噪声、SNR及Fbg单独及4项联合预测NSCLC患者同步放化疗预后的ROC曲线下面积(AUC)分别为0.665(95%CI:0.493~0.837)、0.581(95%CI:0.410~0.752)、0.734(95%CI:0.598~0.870)、0.668(95%CI:0.533~0.803)和0.776(95%CI:0.657~0.895);采用ROC曲线分析获得CT值(56.832%)、噪声(12.283%)、SNR(10.149%)及Fbg(5.102 g/L)的诊断阈值,根据各项指标的阈值得到高平均CT值患者35例,低平均CT值患者25例,高平均CT值患者生存时间明显低于低平均CT值患者,差异有统计学意义(Logrank=25.554,P<0.05)。高噪声患者37例,低噪声患者23例,高噪声患者生存时间明显低于低噪声患者,差异有统计学意义(Logrank=28.109,P<0.05)。高SNR患者38例,低SNR患者22例,高SNR患者生存时间明显高于低SNR患者,差异有统计学意义(Logrank=17.502,P<0.05)。高Fbg患者26例,低Fbg患者34例,高Fbg患者生存时间明显低于低Fbg患者,存在显著差异(Logrank=17.809,P<0.05)。结论:CT扫描相关指标平均CT值、噪声及SNR联合血清纤维蛋白原水平与肿瘤患者预后有关,两者联合检测可预测NSCLC患者同步化疗预后。

Objective:To investigate the predictive efficacy of spiral computed tomography(CT)combined with serum fibrinogen(Fbg)detection in the prognosis of patients with locally advanced non-small cell lung cancer(NSCLC)who underwent concurrent radiotherapy and chemotherapy.Methods:From April 2018 to January 2023,a total of 60 patients with locally advanced NSCLC patients,who admitted to Hefei Cancer Hospital of the Chinese Academy of Sciences and underwent the treatment of concurrent radiotherapy and chemotherapy,were selected.They were divided into survival group(50 cases)and endpoint event group(10 cases)according to the prognosis.Before treatment,both two groups were examined by spiral CT,and the average CT values,noise values,and signal to noise ratio(SNR)values of CT related indicators of two groups were counted by using statistical method.The serum Fbg levels of two groups were detected before treatment,and the follow up was conducted until October 2023,and the record of the follow-up time within 9 months were counted by using statistical method.Kaplan-Meier method and Logrank analysis were used to analyze prognosis.The mean CT values,noise values,SNR and Fbg data were included in the binary regression analysis for the receiver operating characteristic(ROC)curve analysis,so as to obtain the efficacy values of each indicator and the combination of the each indicator in predicting prognosis.Results:The average CT value and noise value of the endpoint event group were significantly higher than those of the survival group,while the SNR was significantly lower than that of the survival group,and the serum Fbg level of the endpoint event group was significantly higher than that of the survival group,and the differences were statistically significant(t=5.445,18.323,7.580,78.628,P<0.05),respectively.The area under curve(AUC)values of ROC curve of average CT value,noise value,SNR,Fbg alone and the combination of 4 indicators were 0.665(95%CI:0.493-0.837),0.581(95%CI:0.410-0.752),0.734(95%CI:0.598-0.870),0.668(95%CI:0.533-0.803)and 0.776(95%CI:0.657-0.895)in predicting the prognosis of concurrent radiotherapy and chemotherapy of NSCLC patients,respectively.The ROC curve was adopted to analyze the diagnostic thresholds of the obtained CT value(56.832%),noise value(12.283%),SNR(10.149%)and Fbg(5.102 g/L).Based on the thresholds of each indicator,35 patients with high average CT value and 25 patients with low average CT value were identified.The survival time of patients with high average CT value was significantly lower than that of patients with low average CT value,and the difference was statistically significant(Logrank=25.554,P<0.05).In these patients,37 patients appeared high noise and 23 patients appeared low noise,and the survival time of patients with high noise was significantly lower than that of patients with low noise,and the difference was statistically significant(Logrank=28.109,P<0.05).The survival time of 38 patients with high SNR was significantly higher than that of 22 patients with low SNR,and the difference was statistically significant(Logrank=17.502,P<0.05).The survival time of 26 patients with high Fbg was significantly lower than that of 34 patients with low Fbg,and the difference was significant(Logrank=17.809,P<0.05).Conclusion:The average CT value,noise value and SNR combined with serum Fbg level of the relative indicators of CT scan relate to the prognosis of patients with tumor,and the combined detection of them can predict the prognosis of NSCLC patients undergoing concurrent radiotherapy and chemotherapy.