酰胺质子转移成像联合预后营养指数预测局部进展期直肠癌新辅助放化疗疗效的价值分析

Value analysis of amide-proton transfer imaging combined with prognostic nutritional index in predicting the efficacy of neoadjuvant chemoradiotherapy for locally advanced rectal cancer

目的:探讨酰胺质子转移(APT)成像定量参数APT信号强度(APT SI)、表观扩散系数(ADC)值联合预后营养指数(PNI)预测局部进展期直肠癌新辅助放化疗(NCRT)治疗疗效的价值。方法:选择接受完整NCRT及手术治疗的98例局部进展期直肠癌患者作为研究对象。NCRT前对患者进行APT检查,测定APT SI和ADC值,计算并记录PNI。对所有研究对象实施NCRT治疗,依据术后病理学结果对患者进行分组,包括病理完全缓解(PCR)组和非PCR组。结果:经NCRT治疗后,98例直肠癌患者中40例(40.82%)达到PCR,58例(59.18%)未达到PCR。PCR与非PCR两组患者的肿瘤最大径差异有统计学意义(P<0.05)。PCR患者的治疗前APT SI和PNI显著高于非PCR患者,治疗前ADC值显著低于非PCR患者,差异有统计学意义(P<0.05)。直肠癌患者治疗前APT SI与ADC值呈显著负相关关系(r=-0.366,P=0.046)。单因素Logistic回归分析结果显示,APT SI、ADC值、PNI与直肠癌患者NCRT后非PCR密切相关(P<0.05)。ROC曲线分析结果显示,APT SI、ADC值、PNI单独及三者联合预测非PCR的敏感度和特异度分别为75.9%和52.5%、69.0%和67.5%、56.9%和72.5%、82.8%和82.5%。结论:APT定量参数及PNI联合有助于预测局部进展期直肠癌患者的NCRT疗效。

Objective:To investigate the value of quantitative parameters of amide-proton transfer imaging(APT)including APT signal intensity(APT SI)and apparent diffusion coefficient(ADC)combined with prognostic nutrition index(PNI)in predicting the efficacy of neoadjuvant chemoradiotherapy(NCRT)for locally advanced rectal cancer.Methods:A total of 98 patients with locally advanced rectal cancer who received complete NCRT and surgical treatment were selected as the study objects.All the patients underwent APT examination before NCRT,and the APT SI and ADC values were determined,and the PNI was calculated and recorded.All subjects were treated with NCRT and divided into pathological complete response(PCR)group and non-PCR group according to postoperative pathological results.Results:After NCRT treatment,40 cases(40.82%)of 98 patients with rectal cancer achieved PCR,and 58 cases(59.18%)did not achieve PCR.There was significant difference in maximum tumor diameter between the two groups(P<0.05).The APT SI and PNI before treatment in PCR patients were significantly higher than those in non-PCR patients,and the ADC before treatment was significantly lower than that in non-PCR patients,with statistical significance(P<0.05).There was a significant negative correlation between APT SI and ADC before treatment in rectal cancer patients(r=-0.366,P=0.046).Univariate logistic regression analysis showed that APT SI,ADC and PNI were closely related to non-PCR after NCRT in rectal cancer patients(P<0.05).The ROC curve analysis results showed that the sensitivity and specificity of APT SI,ADC and PNI alone and the combined were 75.9%and 52.5%,69.0%and 67.5%,56.9%and 72.5%,82.8%and 82.5%,respectively.Conclusion:The combination of APT quantitative parameters and PNI helps to predict the efficacy of NCRT in patients with locally advanced rectal cancer.