本文選題：宮頸癌　切入點：氫質子磁共振波譜　出處：《中南大學》2014年碩士論文

【摘要】：目的 分析宮頸癌新輔助化療(neoadjuvant chemotherapy, NACT)后質子磁共振波譜(hydrogen proton magnetic resonance spectroscopy,1H-MRS)的特征,探討其監(jiān)測宮頸癌NACT療效的價值。 方法 選擇2012年9月-2013年9月中南大學湘雅二醫(yī)院婦科住院治療的局部晚期宮頸鱗癌患者15例。每例患者在化療前、第1次NACT后14天和第2次NACT后14天分別行3次常規(guī)磁共振成像(Magnetic Resonance Imaging,MRI)和三維1H-MRS檢查。定量分析每例患者MRS中膽堿(Choline, Cho)峰(3.2ppm)、肌酸(Creatine, Cre)峰3.0ppm)、2.0ppm峰(2.0ppm)和脂質(Lipid, Lip)峰(1.4ppm、1.3ppm及0.9ppm)等。每例患者在化療前、第1次NACT后14天和根治性手術后,分別采用HE染色和免疫組織化學法檢測宮頸癌病灶的腫瘤細胞數及Ki-67的表達。2次化療后評估療效按最新實體瘤療效評價標準,以T2加權成像上測量的最長腫塊徑線為準。 結果 1.15例患者均完成2次NACT。11例化療有效,4例化療無效,化療有效率為73.3%。15例化療后均行宮頸癌根治性手術治療。術后補充化療8例,放化療7例。 2.15例患者全部成功完成磁共振波譜檢查,化療前后的波譜均可檢測到膽堿峰、肌酸峰、2.0ppm峰和脂質峰�；熡行У膶m頸癌膽堿峰值在化療前、第1次NACT后及第2次NACT后分別為(138.80±63.12)、(81.64±31.61)和(71.27+30.22)；化療無效的在3個時間點分別為(102.37±24.63)、(104.44±20.01)和(108.06±35.13)�；熡行У膶m頸癌膽堿峰值在第2次和第1次化療后分別與化療前相比有顯著差異(p=0.006,p=0.000)；化療無效的在3個不同時間點之間比較無明顯差異(p0.05)。肌酸峰、2.0ppm峰和脂質峰值在不同化療療效組中和不同時間點之間均無顯著差異(p0.05)。 3.化療有效的宮頸癌膽堿峰下面積在化療前、第1次NACT后及第2次NACT后分別為(6.30±2.16)、(3.91±0.97)和(3.03±1.38)；化療無效的在3個時間點分別為(5.34±2.05)、(5.97±2.03)和(5.96±2.18)。化療有效的宮頸癌膽堿峰下面積在第2次和第1次化療后分別與化療前相比有顯著差異(p=0.002,p=0.000)；化療無效的在3個不同時間點無明顯差異(p0.05)。肌酸峰、2.0ppm峰和脂質峰下面積在不同化療療效組中和不同時間點之間均無顯著差異。化療有效的宮頸癌膽堿與膽酸的峰下面積比(Cho/Cr)在化療前、第1次及第2次NACT后分別為(2.43+1.19),(2.13+1.01)和(1.17±1.19),Cho/Cr在第2次和第1次化療后分別與化療前相比有顯著差異(p=0.034,p=0.015)；化療無效的宮頸癌Cho/Cr在3個不同時間點無明顯差異(p0.05)。2.0ppm/Cr、甘油三脂-CH2/Cr、甘油三脂-CH3/Cr和甘油三脂-CH2/-CH3在不同療效組中的不同時間點比較均無顯著性差異(p0.05) 4.在化療有效的宮頸癌中,第2次NACT后的腫瘤細胞數和ki-67的表達均較化療前和第1次NACT后顯著降低(p0.05)；而在化療無效組中,化療前后腫瘤細胞數和ki-67的表達無明顯差異(p0.05)。在化療有效的的宮頸癌中,2次化療后的Cho峰下面積的變化與ki-67的表達變化呈正相關性(r=0.625,P=0.030; r=0.680, P=0.021);第2次NACT后的Cho峰下面積與化療前相比的變化與腫瘤細胞數的表達變化呈正相關性(r==0.720,P=0.012)。 結論 1.宮頸癌的1H-MRS可檢測到Cho峰、Cr峰、2.0ppm峰和Lip峰。cho峰(包括峰值、峰下面積及cho/Cr匕值)反映了宮頸癌新輔助化療后腫瘤組織的代謝變化。 2.1H-MRS中的膽堿峰可望應用于評價宮頸癌新輔助化療的療效。
[Abstract]:objective
Objective to analyze the characteristics of hydrogen proton magnetic resonance spectroscopy (1H-MRS) after neoadjuvant chemotherapy (NACT) in cervical cancer, and to explore its value in monitoring the efficacy of NACT in cervical cancer.
Method
In September 2012 -2013 year in September in Xiangya No.2 Hospital of Central South University gynecological hospital of 15 patients with locally advanced squamous cell carcinoma of the cervix treated cases. Each patient before chemotherapy, first times 14 days after NACT and second NACT respectively for 14 days after 3 times of conventional magnetic resonance imaging (Magnetic Resonance, Imaging, MRI) and 3D 1H-MRS. Quantitative analysis of choline in each case. In patients with MRS (Choline, Cho) peak (3.2ppm), creatine (Creatine, Cre) 3.0ppm), peak 2.0ppm peak (2.0ppm) and lipid (Lipid, Lip) (1.4ppm, 1.3ppm and 0.9ppm peak). Each patient before chemotherapy, first times 14 days after NACT and after radical operation..2 expression in tumor cells after chemotherapy of cervical cancer lesions detection using HE staining and immunohistochemical method and Ki-67 evaluation of the efficacy evaluation according to the latest clinical criteria in solid tumors, with the longest mass measurement of T2 weighted imaging on the line as the standard.
Result
1.15 patients completed 2 times, NACT.11 chemotherapy was effective, 4 cases were ineffective in chemotherapy, and the effective rate of chemotherapy was 73.3%.15. All patients underwent radical operation of cervical cancer after chemotherapy. 8 cases received postoperative chemotherapy and 7 cases received radiotherapy and chemotherapy.
All 2.15 patients successfully completed the magnetic resonance spectroscopy, spectroscopy before and after chemotherapy were detected in choline, creatine peak, 2.0ppm peak and the lipid peak. Effective chemotherapy of cervical cancer in the choline peak before chemotherapy, first NACT and 2 NACT respectively (138.80 + 63.12), (81.64 + 31.61) and (71.27+30.22); chemotherapy ineffective at 3 time points respectively (102.37 + 24.63), (104.44 + 20.01) and (108.06 + 35.13). Effective chemotherapy of cervical cancer in second choline peak times and first times respectively after chemotherapy and chemotherapy was significant (p= 0.006, p=0.000); therapy between 3 different time points had no significant difference (P0.05). Creatine peak, 2.0ppm peak and the lipid peak had no significant difference in efficacy between different chemotherapy group and different time points (P0.05).
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本文編號：1695765