| 摘要: |
| 目的：探究联合应用经直肠超声（TRUS）检查中的多个参数评估局部进展期直肠癌（LARC）新辅助放化疗（NCRT）疗效的价值，并与磁共振肿瘤退缩分级（mrTRG）进行比较。方法：收集96例接受NCRT后，行全系膜切除术（TME）的LARC患者资料。根据病理肿瘤退缩分级（pTRG），将患者分为反应良好组（pTRG0、1级，共34例）和反应不佳组（pTRG2、3级，共62例）。收集治疗前后的临床及超声资料，包括患者的年龄、性别、CEA、CA199、肿瘤下缘距白线距离、长径、厚径、肿瘤内主要动脉的收缩期峰值血流速度（PSV）、阻力指数（RI）、肿瘤的超声造影不均匀强化程度分级（CEUS-IG）等。比较两组患者上述参数的差异，将组间有差异的参数通过二元logistic回归建立多参数预测模型，分析其预测效能，并与mrTRG进行比较。结果：CEUS-IG治疗后、肿瘤长径变化率、PSV变化率、CEUS-IG降级（ΔCEUS-IG）在两组的差异有统计学意义（p<0.05）；余临床及超声参数在两组间的差异无统计学意义（p>0.05）。肿瘤长径变化率、PSV变化率的截断值分别为26.0%和22.5%，准确率分别为63.50%和68.75%。ΔCEUS-IG的准确率为71.90%，低于mrTRG（83.33%，p<0.05）；CEUS-IG治疗后预测pTRG的准确率为83.30%，与mrTRG相当（p>0.05）。建立的预测模型的准确率为84.4%，AUC为0.917，其准确率与CEUS-IG治疗后和mrTRG差异无统计学意义（p>0.05）。结论：CEUS-IG治疗后、肿瘤长径变化率、PSV变化率、ΔCEUS-IG可用于区分NCRT反应良好组和反应不佳组，多参数超声在评估直肠癌NCRT后的疗效中或有与mrTRG相当的应用价值。 |
| 关键词: 经直肠超声 磁共振 直肠癌 肿瘤退缩分级 新辅助放化疗 |
| DOI： |
| 投稿时间：2022-10-09修订日期：2022-12-03 |
| 基金项目: |
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| The Value of Multi-parametric Ultrasound and Magnetic Resonance Imaging in Assessment of Tumor Regression Grade of Locally Advanced Rectal Cancer after Treatment |
| liaozhongfan,luoyuan,jingjigang,yangyin,yanjingwen,zhuanghua |
| (sichaununiversity) |
| Abstract: |
| Objective: To investigate the value of combining multiple parameters of trans-rectal ultrasonography (TRUS) to assess the efficacy of neoadjuvant radiotherapy (NCRT) for locally advanced rectal cancer (LARC)，and compare it with magnetic resonance tumor regression grade(mrTRG).
Methods: Data were collected on 96 patients with LARC who underwent total mesenteric resection (TME) after NCRT. According to the pathological tumor regression grading (pTRG), patients were divided into good response group (pTRG 0 and 1, 34 cases) and poor response group (pTRG 2 and 3, 62 cases). Clinical and ultrasound data before and after treatment were collected, including the age, sex, CEA, CA199 of the patient and distance from the lower edge of the tumor to the Hilton line (Intersphincteric Groove), long diameter and thick diameter of the tumor, the peak systolic velocity (PSV) of the major arteries within the tumor, the resistance index (RI), and the contrast enhanced ultrasound inhomogeneity grade of the tumor (CEUS-IG). The differences in ultrasound parameters between the two groups were compared, and the parameters that differed between the groups were analyzed by binary logistic regression to establish a multi-parameter prediction model and their predictive efficacy were compared with mrTRG.
Results: Before NCRT, the differences of all ultrasound parameters between the two groups were not statistically significant (p>0.05); after NCRT, the differences of CEUS-IGpost, tumor long-diameter change rate, PSV change rate, and downgrade of CEUS-IG (ΔCEUS-IG) were statistically significant in the two groups (p<0.05); the differences in the remaining clinical and ultrasound parameters between the two groups were not statistically significant. The cut-off values of tumor length diameter change rate and PSV change rate were 26.0% and 22.5%, and the accuracy were 63.50% and 68.75%, respectively; The accuracy of ΔCEUS-IG was 71.90%, which was lower than that of mrTRG (83.33%, p<0.05); the accuracy of CEUS-IGpost in predicting pTRG was 83.30%, which was comparable to that of mrTRG (p>0.05). The accuracy of the established regression prediction model was 84.4%, with an AUC of 0.917, and its accuracy was not statistically significant (p>0.05) from both CEUS-IGpost and mrTRG.
Conclusion: Parameters CEUS-IGpost, tumor length-diameter change rate, PSV change rate, and ΔCEUS-IG after NCRT could be used to distinguish the good response group and the poor response group of NCRT, and the multi-parametric ultrasound may have comparable value of applications with mrTRG in assessing the efficacy of rectal cancer after NCRT. |
| Key words: Trans-rectal ultrasonography MRI Rectal cancer Tumor regression grade Neoadjuvant chemoradiotherapy |
