| 摘要: |
| 目的：探讨经直肠三维超声（3D-ERUS）在局部晚期直肠癌新辅助放化疗后病理完全缓解评估中的应用价值。
方法：回顾分析我院局部晚期直肠癌患者98例，所有患者均行标准新辅助放化疗方案后行全直肠系膜切除术，在首次入院一周内和术前放化疗后一周内分别行3D-ERUS，记录相关超声参数，将其分为病理完全缓解组（pCR组）和非缓解组（non-pCR组），比较两组中3D-ERUS参数的差异，采用 Spearman 相关系数法分析各参数与 TRG分级的相关性；采用 ROC 曲线计算各参数对疗效评估的截断值并评价其诊断效能。
结果： NCRT后病变累及长径（r=0.336）、累及最厚径（r=0.403）、累及肠圈（r=0.339）与TRG分级呈正相关（均P＜0.05），累及长径变化率（r=-0.407）、最厚径变化率（r=-0.435）、肠圈变化率（r=-0.408）、血流分级变化率（r=-0.235）与TRG分级呈负相关（均P＜0.05）。ROC曲线显示3D-ERUS预测pCR的诊断性能，其中累及长径变化率的截断值为29％，敏感性为70.0％，特异性为76.9％，累及最厚变化率的截断值为44％，敏感性为80.0％，特异性为76.9％，累及肠圈变化率的截断值为33％，敏感性为70.0％，特异性为79.5％，累及血流分级变化率的截断值为0％，敏感性为70.0％，特异性为57.7％，NCRT后累及长径的截断值为39mm，敏感性为95.0％，特异性为39.7％，NCRT后累及最厚径的截断值为10mm，敏感性为100.0％，特异性为47.7％，NCRT后累及肠圈的截断值为25％，敏感性为70.0％，特异性为70.5％。
结论：3D-ERUS在局部晚期直肠癌新辅助放化疗后pCR评估中具有重要价值，其所测量的NCRT后累及长径、累及最厚径、累及肠圈，累及长径变化率、最厚径变化率、肠圈变化率、血流分级变化率具有较高的准确性。 |
| 关键词: 经直肠三维超声，直肠癌，新辅助放化疗，肿瘤退缩分级 |
| DOI： |
| 投稿时间：2020-10-27修订日期：2020-11-16 |
| 基金项目: |
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| Application value of three-dimensional Endorectal ultrasound in assessment of complete pathologic response after neoadjuvant chemoradiation therapy for local advanced rectal cancer |
| JIN Xin,LUO Xiaomao,CHEN Dong,CHEN Haitao,ZHANG Yingxian,CHUAN Zhirui |
| (Department of Ultrasound,The Third Affiliated Hospital of Kunming Medical University) |
| Abstract: |
| Objectives: To investigate the value of three-dimensional Endorectal ultrasound in evaluating complete pathologic response after preoperative neoadjuvant chemoradiation therapy for locally advanced rectal cancer.
Methods: 98 patients with locally advanced rectal cancer in our hospital were retrospectively analyzed. All patients underwent total mesorectal excision after neoadjuvant chemoradiation therapy. 3D-Endorectal ultrasound was performed within one week of first admission and one week after preoperative neoadjuvant chemoradiation therapy. The correlation between each parameter and TRG grade was analyzed by Spearman correlation method; ROC curve was used to evaluate the diagnostic efficacy of the parameters.
Results: There was a positive correlation between involved length（r=0.336），thickness（r=0.403）, intestine（r=0.339） and TRG grade (all P<0.05), a negative correlation between the length change rate（r=-0.407）, the thickness change rate（r=-0.435）, the invasion of intestine change rate（r=-0.408） and the blood flow change rate（r=-0.235） and TRG grade after neoadjuvant chemoradiation therapy (all P<0.05).The ROC curve shows the diagnostic performance 3D-ERUS predictive pCR,including the cut-off value of the length change rate is 29％,the sensitivity and specificity is respectively 70.0％, 76.9％,the thickness change rate is 44% ,the sensitivity and specificity is respectively 80.0％, 76.9％, the invasion of intestine change rate is 33%, the sensitivity and specificity is respectively70.0％, 79.5％, the blood flow change rate is 0％, the sensitivity and specificity is respectively70.0％, 57.7％,the cut-off value of the involved length was 39 mm ,the sensitivity and specificity is respectively95.0％, 39.7％,the involved thickness was 10 mm, the sensitivity and specificity is respectively100.0％, 47.7％,the involved intestine was 25％,the sensitivity and specificity is respectively70.0％, 70.5％ after neoadjuvant chemoradiation therapy.
Conclusion: 3D-Endorectal ultrasound is of great value in the assessment of complete pathologic response after neoadjuvant chemoradiation therapy for local advanced rectal cancer. The involved length, thickness and intestine, the length change rate, the thickness change rate, the invasion of intestine change rate and the blood flow change rate after neoadjuvant chemoradiation therapy measured on 3D-Endorectal ultrasound present high accuracy in prediction of complete pathologic response. |
| Key words: Three-dimensional endorectal ultrasound Rectal cancer Neoadjuvant chemoradiotherapy Tumor regression grade |
