| 摘要: |
| 摘要 目的 探讨经直肠双平面超声（TRUS）对局部进展期直肠癌（LARC）新辅助放化疗（nCRT）后疗效评估及再分期的价值。方法 回顾性分析于我院行nCRT的106例LARC患者的临床病理资料，按病理退缩结果，分为反应良好组（pTRG 0、1 级）58例和反应不良组（pTRG 2、3 级）48例；完全缓解组（pCR组）42例和非完全缓解组（非pCR组）64例。所有患者均于nCRT前、后行TRUS检查，分别记录肿瘤长径、厚径、血流阻力指数（RI）、弹性成像（SE）评分、微血流（MFI）分级、nCRT后超声uT分期及肿瘤退缩分级(uTRG)，比较uT分期与pT分期、uTRG分级与pTRG分级一致性；比较pCR组与非pCR组超声参数的差异，绘制受试者工作特征（ROC）曲线评估TRUS参数对直肠癌nCRT后pCR的评估价值。结果 uT与pT分期符合率为65.1%（Kappa=0.517，P<0.05），其中T3期准确率最高，为78.8%；分为反应良好组和反应不良组后，uTRG与pTRG整体符合率达89.6%（Kappa=0.789，P<0.05）。pCR组与非pCR组nRCT后肿瘤长径、厚度、RI值、SE及MFI降级差异均有统计学意义（均P<0.05）；组间比较，pCR组治疗后的长径、厚度、RI小于非pCR组，长径、厚度、RI缩小率大于非pCR组，差异有统计学意义(均P<0.05)。ROC曲线分析显示长径、厚度、RI变化率评估LARC患者nCRT后pCR的截断值分别为67.75%、71.75%、36.88%，对应的AUC面积为0.884、0.836、0.857，敏感性为84.4%、92.2%、93.8%，特异性为83.3%、76.2%、66.7%。结论 TRUS对LARC行nCRT后uTRG分级与pTRG分级具有较好一致性，对pCR有较好的评估价值。 |
| 关键词: 超声检查，双平面，经直肠 直肠肿瘤，局部进展期 新辅助放化疗 再分期 肿瘤退缩分级 完全缓解 |
| DOI： |
| 投稿时间：2024-08-29修订日期：2024-09-30 |
| 基金项目:重庆市技术创新与应用示范社会民生类一般项目（cstc2018jscx-msybX0018） |
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| Value of biplane transrectal ultrasonography in assessing the efficacy of neoadjuvant chemoradiotherapy and restaging for locally advanced rectal cancer |
| XIAQIN |
| () |
| Abstract: |
| ABSTRACT Objective To investigate the value of transrectal biplane ultrasound (TRUS) for restaging and efficacy prediction of locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT). Methods The clinicopathological data of 106 patients with LARC who received nCRT in our hospital were retrospectively analyzed and divided into the good response group (pTRG 0, 1, n=58) and the poor response group (pTRG 2, 3, n=48); the complete pathologic response group（pCR group, n=42）and non-response group（non-pCR group, n=64）.All patients underwent TRUS before and after nCRT , recording tumor length, thickenss, flow resistance index , elastography score, micro-flow grade, ultrasound T stage and TRG stage after nCRT . Comparing the consistency of uT stage and uTRG with pT stage and pTRG . The differences of ultrasound parameters between pCR and non-pCR group were compared. ROC curve was drawn to evaluate the value of TRUS parameters for pCR after nCRT in LARC. Results The concordance rate between uT and pT stage was 65.1% (Kappa = 0.517, P <0.05), and T3 had the highest accuracy of 78.8%. The concordance rate between uTRG and pTRG was 89.6% (Kappa = 0.789, P <0.05). There were significant differences in tumor length, thickenss, RI value, SE score, MFI grade both the pCR group and the non-pCR group after chemotherapy（all P <0.05）.The intra group comparison showed that tumor length, thickness and RI value of pCR group were less than those of npCR group while the length, thickness and RI value reduction rate of pCR group were higher than those of npCR group after chemotherapy, the difference were statistically significant（all P <0.05）. ROC curve showed that the cut-off values of length, thickness, and RI reduction rate to evaluate pCR after nCRT were 67.75%, 71.75%, 36.88%, with corresponding AUC areas of 0.884, 0.836, and 0.857, sensitivity of 84.4%, 92.2%, 93.8%, and specificities of 83.3%, 76.2%, and 66.7%, respectively. Conclusion TRUS shows good agreement with pTRG grade, and has great value in the assessment of pCR of locally advanced rectal cancer after neoadjuvant chemotherapy. |
| Key words: Ultrasonography, biplane, endorectal Rectal tumor, locally advanced stage Neoadjuvant chemoradiation Restaging Tumor withdrawal grade Complete remission |
