食管鳞状细胞癌病理图像特征预后价值分析

目的探讨食管鳞状细胞癌(ESCC)患者病理图像特征与临床病理特征及生存期的关系,以及在ESCC预后诊断中的价值。方法选取2009-01-01-2010-12-31山西省肿瘤医院ESCC患者73例为研究对象,使用简单随机化方法分为训练组(51例)和验证组(22例)。免疫组织化学法检测患者肿瘤组织中氨基甲酰磷酸合成酶Ⅱ、天冬氨酸转氨甲酰酶和二氢乳清酸酶(CAD)蛋白的表达水平,并采集病理图像,Python编程提取图像特征,单因素方差分析和最小绝对收缩和选择算子(LASSO)回归筛选特征、构建预后模型并验证。Cox回归分析预后相关因素,构建组合模型列线图,评估其对ESCC预后的预测能力。结果训练组CAD质(χ^(2)=20.011)和CAD核(χ^(2)=21.400)高和低表达患者的生存率差异无统计学意义,均P>0.05;验证组CAD质(χ^(2)=20.949)和CAD核(χ^(2)=20.458)高和低表达患者生存率差异无统计学意义,均P>0.05。训练组中,高图像分数和低图像分数患者生存率分别为8.0%和42.3%,差异有统计学意义,χ^(2)=210.476,P=0.001;验证组中,高图像分数和低图像分数患者生存率分别为33.3%和100.0%,差异有统计学意义,χ^(2)=24.183,P=0.041。Cox回归分析显示,图像分数是ESCC独立预后风险因素,采用图像分数和传统TNM分期构建组合模型列线图。训练组中,TNM分期、图像分数和组合模型的一致性指数(C-index)分别为0.602(95%CI为0.507~0.696)、0.664(95%CI为0.556~0.772)和0.664(95%CI为0.556~0.772);验证组中,TNM分期、图像分数和组合模型的C-index分别为0.560(95%CI为0.421~0.699)、0.647(95%CI为0.466~0.828)和0.668(95%CI为0.488~0.849)。图像分数和组合模型的预测性能优于传统TNM分期。结论由CAD免疫组化的组织病理学图像提取的图像特征在ESCC中具有潜在的预后价值,基于图像分数和TNM分期构建的列线图可作为ESCC的预后模型。

Value of Multi-slice spiral CT in diagnosis of malignant gastrointestinal stromal tumors

Objective： The aim of this study was to investigate the value of multi-slice spiral CT （MSCT） in the diagnosis of malignant gastrointestinal stromal tumors （GISTs）. Methods： Twenty-seven cases of MSCT images of malignant GIST proved by surgery and pathology were retrospectively analyzed. Both plain and enhanced CT scan was performed and multiplanar reconstruction was made in all cases. Results： The lesions originated from the stomach （n = 11）, small intestine （n = 9）, colon （n = 4）, rectum （n = 1）, and mesentery （n = 2）. The transverse diameters of mass were 4.2-22 cm, the edges clearly （n = 12）, unclearly （n = 15）. The mass were mainly irregular in shape Iobulated （n = 19）. The lesions were mainly heterogeneity on plain scan, moderate to marked enhancement in arterial phase and durative enhanced in venous phase. Cystic necrosis were observed in all the lesions, 9 cases were cystic and solid mixed mass. Hepatic metastases （n = 4）, pulmonary metastasis （n = 1）, lymphatic metastasis （n = 2） were detected. The accuracy rate of MSCT diagnosis for location and pathologic features of GISTs were 85.2% （23/27） and 77.8% （21/27）. Conclusion： Two-phase MSCT examination and axial images combined with multiplanar reconstruction images have important value for diagnosis of malignant GIST.