摘要
目的:研究CT值评价局部晚期胃癌病人胃的血供在临床的应用价值。方法:从2013年9月起对我院收治的局部晚期胃癌病人进行研究。通过CT检查胃癌与邻近重要脏器、血管的关系,可切除者行胃癌根治术,不能切除者先行术前化疗,再手术治疗。计算门静脉期和平扫期肿瘤的CT值,并以同层主动脉的CT值校正,获得主动脉校正CT(aorta adjusted CT, AACT)值。术前化疗病人给予动静脉结合口服化疗,评估化疗反应。结果:至2017年11月,完成300例胃癌病人,其中直接手术179例,接受术前化疗121例。病人年龄为(59.03±10.82)岁,AACT值为0.574 1±0.118 3。不同性别、肿瘤位置及大体类型病人的肿瘤AACT值均无统计学差异(P>0.05)。病理组织学类型方面,高中分化腺癌、低分化腺癌以及印戒细胞癌的AACT值在两两之间均有统计学差异(P分别为0.024、0.001、0.030)。术前化疗有效组87例,AACT值为0.628 6±0.192 2,化疗无效组34例,AACT值为0.494 5±0.245 1,两组AACT值有显著统计学差异(P<0.001)。术前化疗对富血供的肿瘤具有较好的疗效。AACT阈值为0.516 4,其灵敏度和特异度分别为80.5%和67.6%。受试者工作特征曲线下面积为0.758。结论:分化程度高的胃癌血供好。AACT高水平下局部不能切除的胃癌病人肿瘤血供可能更丰富,术前化疗效果好,获得手术机会。
Objective To evaluate the clinical utility of computed tomography(CT) value to assess tumor blood supply in patients with local late stage of gastric cancer. Methods Since September 2013, the patients with local late stage of gastric cancer admitted to our hospital have been studied. After CT examination of association of cancer with adjacent organs and blood vessels, the patients who could be resected were treated with radical dissection of gastric cancer. The others who could not be resected were treated with preoperative chemotherapy before surgical treatment. CT values in lesions in both portal venous phase and plain phase were calculated and adjusted to aorta CT(AACT) values. The patients with preoperative chemotherapy were administered intra-arterial and intravenous chemotherapy combined with oral S-1 and the chemotherapeutic response was evaluated. Results By November 2017, 300 cases with gastric cancer were treated including 179 patients with direct surgery and 121 cases with preoperative chemotherapy. The ages of patients were(59.03 ±10.82) years, and AACT value was 0.574 1±0.118 3. There was no significant difference in AACT values of tumor in gender, tumor location and general type(P>0.05). In terms of histological types, there were statistically significant differences in AACT values of pathological type between well and poor differentiated adenocarcinoma(P=0.024), between well differentiated adenocarcinoma and signet ring cell carcinoma(P=0.001) and between poor differentiated adenocarcinoma and signet ring cell carcinoma(P=0.030), respectively. There were 87 cases in tumor response group with AACT value(0.628 6±0.1922) and 34 cases in non-response group with AACT value(0.494 5±0.245 1) and significant difference in AACT values was present between two groups(P<0.001). Preoperative chemotherapy had better effect for the tumor with abundant blood supply. The threshold 0.516 4 of AACT value had sensitivity 80.5% and specificity 67.6% of chemotherapy effect respectively.The area under the receiver operating characteristic curve was 0.758. Conclusions The well differentiated gastric cancer would be more abundant blood supply. The patients with local unresectable gastric cancer with high AACT value may have abundant tumor blood supply and have better results from preoperative chemotherapy and opportunity of surgery.
作者
叶晨
徐沁梅
相小松
周长圣
李国立
YE Chen;XU Qinmei;XIANG Xiaosong;ZHOU Changsheng;LI Guoli(General Surgery Institute,Jinling Hospital, Nanjing Medical University, Jiangsu Nanjing 210002, China;Department of Medical Imaging, Jinling Hospital, Nanjing Medical University, Jiangsu Nanjing 210002, China)
出处
《外科理论与实践》
2019年第1期45-50,共6页
Journal of Surgery Concepts & Practice
关键词
胃癌
多层螺旋CT
CT值
术前化疗
Gastric cancer
Multi-detector computed tomography(MDCT)
CT value
Preoperative chemotherapy
