本文選題：腎細(xì)胞癌 + 透明細(xì)胞癌��； 參考：《上海交通大學(xué)》2015年博士論文

【摘要】：目的:建立腎臟腫瘤在增強(qiáng)CT圖像上強(qiáng)化程度的測(cè)量方法,研究腎透明細(xì)胞癌強(qiáng)化特征與腫瘤Fuhrman分級(jí)的關(guān)系。對(duì)象和方法:回顧性分析255例住院接受腎癌根治術(shù)或腎臟部分切除術(shù)的腎透明細(xì)胞癌患者,獲取其臨床一般資料、多期增強(qiáng)CT圖像和手術(shù)標(biāo)本病理檢查結(jié)果。在增強(qiáng)CT圖像上測(cè)量、記錄相關(guān)影像學(xué)特征及參數(shù),包括腫瘤最大徑、腫瘤強(qiáng)化特征、是否存在腫瘤內(nèi)鈣化、是否為囊性病灶、腫瘤邊緣光整度等。建立腎臟腫瘤強(qiáng)化程度的測(cè)量方法,定義代表強(qiáng)化程度的四個(gè)指標(biāo)(TEV1、REV1、TEV2、REV2),研究強(qiáng)化指標(biāo)與腎透明細(xì)胞癌Fuhrman分級(jí)之間的關(guān)系及其對(duì)后者的預(yù)測(cè)。將影像學(xué)特征、參數(shù)以及相關(guān)臨床一般資料納入多因素分析,尋找與腫瘤高Fuhrman分級(jí)相關(guān)的獨(dú)立因素。前瞻性納入45例透明細(xì)胞癌患者對(duì)前述所得結(jié)論進(jìn)行驗(yàn)證。結(jié)果:255例腎透明細(xì)胞癌患者中位年齡59歲,其中男性196例(76.9%),女性59例(23.1%),腫瘤最大徑中位數(shù)4.4cm。Fuhrman分級(jí)1-4級(jí)分別為24例(9.4%)、188例(73.7%)、40例(15.7%)、3例(1.2%)。四個(gè)強(qiáng)化指標(biāo)在不同F(xiàn)uhrman分級(jí)之間存在顯著的組間差異(p0.001),隨著Fuhrman分級(jí)升高,四個(gè)強(qiáng)化指標(biāo)均呈現(xiàn)下降趨勢(shì)。高級(jí)別(Fuhrman 3-4級(jí))透明細(xì)胞癌的TEV1、REV1、TEV2、REV2值均顯著低于低級(jí)別(Fuhrman 1-2級(jí))透明細(xì)胞癌(p0.001)。使用強(qiáng)化指標(biāo)對(duì)腫瘤Fuhrman分級(jí)的高低進(jìn)行預(yù)測(cè),ROC曲線圖中TEV1、REV1、TEV2、REV2的曲線下面積分別為0.882、0.926、0.847、0.871。以0.65為臨界值,REV1對(duì)高Fuhrman分級(jí)預(yù)測(cè)的敏感度和特異度分別為0.84、0.93。將REV1值與其他臨床、影像學(xué)變量納入多因素分析,作為腫瘤Fuhrman分級(jí)高低的預(yù)測(cè)因素,logistic回歸顯示,患者高齡、腫瘤邊緣不規(guī)則和低REV1值為腫瘤高Fuhrman分級(jí)的獨(dú)立預(yù)測(cè)因素。在驗(yàn)證隊(duì)列中,REV1≤0.65對(duì)高Fuhrman分級(jí)預(yù)測(cè)的敏感度和特異度分別為0.83、0.87。結(jié)論:腎透明細(xì)胞癌在增強(qiáng)CT上的強(qiáng)化程度與Fuhrman分級(jí)呈負(fù)相關(guān),患者高齡、腫瘤邊緣不規(guī)則以及腫瘤低強(qiáng)化,構(gòu)成腎透明細(xì)胞癌高Fuhrman分級(jí)的獨(dú)立預(yù)測(cè)因素。該評(píng)估方法有助于腎臟腫瘤的侵襲性評(píng)估,對(duì)臨床決策可能具有指導(dǎo)意義。
[Abstract]:Objective: to study the relationship between enhancement characteristics of renal clear cell carcinoma and Fuhrman grade of renal tumor. Participants and methods: 255 cases of renal clear cell carcinoma who underwent radical nephrectomy or partial nephrectomy were retrospectively analyzed. The clinical data, multiphase enhanced CT images and pathological findings of the specimens were obtained. The imaging features and parameters were recorded on enhanced CT images, including tumor maximum diameter, tumor enhancement, calcification in tumor, cystic lesion, margin light integration and so on. To establish a method to measure the degree of enhancement of renal tumors, and to define four indicators representing the degree of enhancement: TEV1 / REV1 / TEV2 / REV2. To study the relationship between enhancement and Fuhrman grade of renal clear cell carcinoma (RCC) and the prediction of the latter. Imaging features, parameters and general clinical data were included in multivariate analysis to find the independent factors associated with high Fuhrman grade of tumor. A prospective study of 45 patients with clear cell carcinoma was performed to verify the above conclusions. Results the median age of 255 cases of renal clear cell carcinoma was 59 years old. Among them, 196 cases were male (76. 9%) and 59 cases were female (23. 1%). The median 4.4cm.Fuhrman grade 1-4 of the median diameter of the tumor was 24 cases (9. 4%) respectively. There were significant differences among the four enhancement indexes among different Fuhrman grades, and with the increase of Fuhrman grading, the four enhancement indexes showed a downward trend. The values of TEV1, REV1, TEV2 and REV2 were significantly lower than those of low grade Fuhrman 1-2) of clear cell carcinoma (P 0.001). The area under the curve of TEV1 / REV1 / TEV2 / REV2 was 0.8820.92 / 0.926 / 0.847 / 0.871respectively, using the enhancement index to predict the level of tumor Fuhrman grade in the curve of TEV1 / REV1 / TEV2REV2 / REV2 / REV2 / REV2, respectively. The sensitivity and specificity of 0. 65 as the critical value for high Fuhrman grade prediction were 0. 84 and 0. 93 respectively. REV1 and other clinical and imaging variables were included in the multivariate analysis. As a predictor of tumor Fuhrman grade, the elderly patients, irregular tumor margin and low REV1 were independent predictors of high Fuhrman grade. In the validation cohort, the sensitivity and specificity of REV1 鈮，

本文編號(hào)：1881861