【摘要】：目的：盡管近年來胃癌的發(fā)病率有下降趨勢，但胃癌仍是死亡率較高的常見腫瘤，這與患者確診時腫瘤分期較晚有關(guān)。近期國內(nèi)、外的研究表明進(jìn)展期胃癌術(shù)前化療可使腫瘤降期，有效提高手術(shù)切除率和生存時間。而術(shù)前客觀、準(zhǔn)確的療效評價對選擇下一步治療方案和預(yù)后推斷至關(guān)重要。目前，對于胃癌術(shù)前化療療效評價缺乏統(tǒng)一的標(biāo)準(zhǔn)，臨床上多應(yīng)用胃癌T、N、M分期的變化，或RECIST療效評價標(biāo)準(zhǔn)，計算化療前后腫瘤最長徑的變化對療效評價。值得注意的是，多層螺旋CT（Multislice SpiralComputed Tomography，MSCT）對于N分期的準(zhǔn)確性并不理想，其對化療后T分期的準(zhǔn)確率也有所降低。胃癌分型、胃的蠕動、胃腔充盈程度及瘤體化療后自身的變化影響長徑測量的準(zhǔn)確性。隨著多層螺旋CT各種后處理技術(shù)、軟件的不斷開發(fā)，通過軟件可對胃腫瘤的密度、厚度及體積進(jìn)行測量，在進(jìn)展期胃癌術(shù)前化療療效的評估中顯示出越來越多的優(yōu)勢。國內(nèi)、外對CT測量腫瘤體積、密度、厚度評價進(jìn)展期胃癌術(shù)前化療療效的研究較少。 本研究采用多層螺旋CT對進(jìn)展期胃癌術(shù)前化療前后進(jìn)行增強掃描，記錄CT測量腫瘤體積、密度及厚度的變化，通過與RECIST療效評價標(biāo)準(zhǔn)對比，討論多層螺旋CT掃描在進(jìn)展期胃癌患者術(shù)前化療療效評價中的應(yīng)用,初步找出進(jìn)展期胃癌術(shù)前化療療效評價的最佳聯(lián)合指標(biāo)。數(shù)據(jù)用SPSS13.0統(tǒng)計學(xué)軟件處理，P＜0.05認(rèn)為差異具有統(tǒng)計學(xué)意義。 方法：收集2010年12月至2013年1月在河北省腫瘤醫(yī)院經(jīng)胃鏡咬檢病理證實的胃癌患者89例，其中男性66例，女性23例，年齡31～78歲，平均年齡57.51±10.96歲。均行MSCT增強掃描，影像學(xué)評估為T3、T4期且為M0，既往未經(jīng)化療治療，且無明顯化療禁忌。術(shù)前給予化療（Xelox或SOX）2-3個療程，化療結(jié)束后1周內(nèi)再行MSCT增強掃描評估。分別測量化療前與化療后腫瘤的總最長徑、體積、密度及厚度，計算化療前后各數(shù)據(jù)的變化。依據(jù)RECIST1.1標(biāo)準(zhǔn)對術(shù)前化療療效進(jìn)行評價，將化療后療效分為完全緩解(Complete Remission,CR)、部分緩解（PartlyRemission,PR）、穩(wěn)定（Stable disease,SD）、進(jìn)展（Progression disease,PD），其中CR、PR歸為有效組，SD、PD歸為無效組。各測量數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析，與RECIST療效評價行相關(guān)性分析，應(yīng)用接受者操作特征曲線（receiver operating characteristic curve，ROC曲線），試圖找出MSCT增強掃描在進(jìn)展期胃癌化療療效評價中最佳的指標(biāo)，確定其最佳閾值及其敏感性和特異性。 結(jié)果： 1化療有效組與無效組之間平均年齡差異無統(tǒng)計學(xué)意義（P=0.941）。 2化療有效組與無效組之間性別差異無統(tǒng)計學(xué)意義（P=0.617）。 3化療后腫瘤密度（69.61±14.59HU）較化療前腫瘤密度（77.48±15.17HU）減�。≒=0.000）；化療后腫瘤體積（71.2±52.45cm3）較化療前腫瘤體積（78.07±50.33cm3)減�。≒=0.033）；化療后腫瘤厚度（13.25±3.58mm）較化療前（14.58±4.28mm）減�。≒=0.006）,三者差異均有統(tǒng)計學(xué)意義。 4化療有效組和無效組腫瘤密度減小率分別為18.73%±14.78%和11.34%±9.31%（P=0.024），差異有統(tǒng)計學(xué)意義；化療有效組和無效組體積減小率分別為36.51%±12.24%和12.57%±9.16%（P=0.01），差異有統(tǒng)計學(xué)意義；化療有效組和無效組腫瘤厚度減小率分別為14.58±4.28%和7.4%±5.92%（P=0.201），，還不能說明兩組間差異有統(tǒng)計學(xué)意義。 5CT腫瘤體積減小率與RECIST療效評價的相關(guān)性r=0.547（P=0.001）,呈中度相關(guān)。CT腫瘤密度減小率與RECIST療效評價的相關(guān)性r=0.36（P=0.013）,呈低度相關(guān)。 6化療前后腫瘤體積減小率曲線下面積0.907（0.784～1.031），如果將腫瘤體積減少率11.73%作為評價術(shù)前化療有效的閾值，其預(yù)測胃腫瘤最長徑減少率評價化療有效的敏感度是100%，特異性66.7%。 結(jié)論： 1. MSCT增強掃描腫瘤密度、體積減小率可以幫助評估進(jìn)展期胃癌化療的療效。 2. MSCT增強掃描腫瘤體積減小率對進(jìn)展期胃癌化療療效的評價優(yōu)于密度減小率。 3.如果將腫瘤體積減小率11.73%作為評價化療有效的閾值，其預(yù)測腫瘤最長徑減小率評價化療有效的敏感度是100%，特異性66.7%。
[Abstract]:Objective: Despite the decreasing incidence of gastric cancer in recent years, gastric cancer is still a common tumor with a high mortality rate, which is related to the late staging of the tumor when the patient is diagnosed. At present, there is no uniform standard for evaluating the curative effect of preoperative chemotherapy for gastric cancer. T, N, M stages or RECIST criteria are often used to evaluate the curative effect of preoperative chemotherapy for gastric cancer. Gastric cancer typing, gastric peristalsis, gastric cavity filling and changes in tumor itself after chemotherapy affect the accuracy of length measurement. With the development of various post-processing techniques of multi-slice spiral CT, software has been developed. The software can be used to measure the density, thickness and volume of gastric tumors, showing more and more advantages in the evaluation of preoperative chemotherapy efficacy for advanced gastric cancer.
In this study, multi-slice spiral CT (MSCT) was used to contrast the volume, density and thickness of advanced gastric cancer before and after preoperative chemotherapy. The application of MSCT in preoperative chemotherapy evaluation of advanced gastric cancer was discussed by comparing with RECIST. The data were processed by SPSS13.0 statistical software, and the difference was statistically significant (P<0.05).
Methods: From December 2010 to January 2013, 89 patients with gastric cancer, including 66 males and 23 females, aged 31-78, with an average age of 57.51 [10.96], who were confirmed by gastroscopic biopsy in Hebei Cancer Hospital, underwent enhanced MSCT scan. All patients were evaluated as T3, T4 and M0 by imaging. They had not received chemotherapy before and had no obvious contraindication of chemotherapy. Before chemotherapy (Xelox or SOX) 2-3 courses, after chemotherapy within one week after the end of MSCT enhanced scan evaluation. Chemotherapy before and after the total tumor diameter, volume, density and thickness were measured, calculated before and after the changes in the data before and after chemotherapy. According to RECIST 1.1 standard, preoperative chemotherapy efficacy was evaluated, the efficacy after chemotherapy was divided into complete remission (CR). Complete Remission, CR, PR, Stable Disease, Progression Disease (PD), CR, PR were classified as effective group, SD, PD were classified as ineffective group. By using ristic curve and ROC curve, we try to find out the best index of MSCT enhanced scan in evaluating the curative effect of advanced gastric cancer chemotherapy, and determine the best threshold, sensitivity and specificity.
Result:
1 there was no significant difference in mean age between the effective group and the invalid group (P=0.941).
2 there was no significant difference in sex between the effective group and the invalid group (P=0.617).
3 Tumor density (69.61 + 14.59 HU) after chemotherapy was significantly lower than that before chemotherapy (77.48 + 15.17 HU) (P = 0.000); tumor volume (71.2 + 52.45 cm 3) after chemotherapy was significantly lower than that before chemotherapy (78.07 + 50.33 cm 3) (P = 0.033); tumor thickness (13.25 + 3.58 mm) after chemotherapy was significantly lower than that before chemotherapy (14.58 + 4.28 mm) (P = 0.006). Significance.
4 The tumor density reduction rates of the effective group and the ineffective group were 18.73% + 14.78% and 11.34% + 9.31% (P = 0.024), respectively, and the difference was statistically significant. The volume reduction rates of the effective group and the ineffective group were 36.51% + 12.24% and 12.57% + 9.16% (P = 0.01), respectively. 14.58 + 4.28% and 7.4% + 5.92% (P=0.201) did not indicate that the difference between the two groups was statistically significant.
The correlation between tumor volume reduction rate and RECIST efficacy was moderately correlated (r = 0.547, P = 0.001). The correlation between tumor density reduction rate and RECIST efficacy evaluation was low (r = 0.36, P = 0.013).
6. The area under the curve of tumor volume reduction rate before and after chemotherapy was 0.907 (0.784-1.031). If the tumor volume reduction rate was 11.73% as the threshold to evaluate the effectiveness of preoperative chemotherapy, the sensitivity and specificity of predicting the longest diameter reduction rate of gastric tumor for evaluating the effectiveness of chemotherapy were 100% and 66.7% respectively.
Conclusion:
1. MSCT enhanced scan density and volume reduction rate can help evaluate the efficacy of chemotherapy for advanced gastric cancer.
2. The tumor volume reduction rate of MSCT enhanced scan is superior to the density reduction rate in evaluating the efficacy of chemotherapy for advanced gastric cancer.
3. If the tumor volume reduction rate was 11.73% as the threshold for evaluating the effectiveness of chemotherapy, the sensitivity and specificity of predicting the maximum diameter reduction rate for evaluating the effectiveness of chemotherapy were 100% and 66.7% respectively.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R735.2;R816.5

【參考文獻(xiàn)】

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本文編號：2233451