摘要
目的探讨多层螺旋CT(multisliecs helieal CT,MSCT)对局部进展期胃间质瘤患者术前治疗疗效及预后的评估价值。方法回顾性分析2012年10月至2014年10月河北医科大学第四医院接受伊马替尼术前治疗的30例局部进展期胃间质瘤患者,在接受术前治疗前后均行MSCT检测,测量原发病灶最长径、CT值、肿瘤体积的变化。分别分析Choi评分、肿瘤体积减少率与组织学疗效评价的相关性。绘制ROC曲线确定鉴别术前治疗有效与否的肿瘤体积减少率的界定值,并制定新的分级标准。采用Kaplan-Meier法绘制生存曲线,观察新分级标准下术前治疗有效组和无效组患者的总生存率。结果30例局部进展期胃间质瘤患者接受术前治疗的中位时间为8(4~14)个月,术后病理组织学疗效评价结果为轻微效应4例(13%),低度效应3例(10%),中度效应17例(57%),高度效应6例(20%)。Choi评分与组织学疗效评价呈中度相关(R=0.512,P<0.05),肿瘤体积减少率与组织学疗效评价结果呈强相关(R=0.620,P<0.05)。以肿瘤体积减少率45.83%作为有效阀值时,其ROC曲线下AUC最大,敏感性和特异性分别为87.0%、85.7%。30例患者5年总生存率为87%。依据新的体积分级标准,术前治疗有效组和无效组患者的5年生存率分别为95%、67%,差异有统计学意义(P<0.05)。结论MSCT测量Choi评分和肿瘤体积减少率均可以评价局部进展期胃间质瘤患者的术前治疗疗效,并且肿瘤体积测量标准在预后判断中也有一定的价值。
Objective To evaluate multislices helical CT(MSCT)on the efficacy and prognosis of preoperative treatment for locally advanced gastric stromal tumors(GIST).Methods From Oct 2012 to Oct 2014 at the Fourth Hospital of Hebei Medical University 30 patients received MSCT before and after preoperative imatinib treatment to measure the changes of the GIST longest diameter,CT value and tumor volume of the primary lesion.The correlation of Choi score,tumor volume reduction rate and histological efficacy evaluation were analyzed.ROC curve was drew.Kaplan-Meier method was used to draw survival curves,and the overall survival rates under the new classification were calculated.Results The median time for preoperative treatment was 8(4 to 14)months.Postoperative pathology showed 4 cases(13%)with mild effects and 3 cases(10%)with low effects.Seventeen cases(57%)with moderate effect and 6 cases(20%)with high effect.Choi score was moderately correlated with histological efficacy evaluation(R=0.512,P<0.05),and tumor volume reduction rate was strongly correlated with histological efficacy evaluation results(R=0.620,P<0.05).When the tumor volume reduction rate of 45.83% was used as the effective threshold,the AUC under the ROC curve was the largest,and the sensitivity and specificity were 87.0% and 85.7%,respectively.The 5-year overall survival rate of 30 patients was 87%.According to the new volume grading standard,the 5-year survival rates of the effective group and the ineffective group were 95% and 67%(P<0.05),respectively.Conclusion MSCT measurement of Choi score and tumor volume reduction rate can evaluate the efficacy of preoperative treatment in patients with locally advanced GIST,and tumor volume measurement standards also have certain value in prognosis perdiction.
作者
郝英杰
郑涛
刘洋
赵群
李勇
檀碧波
范立侨
郭洪海
丁平安
田园
杜夏宇
杨沛刚
Hao Yingjie;Zheng Tao;Liu Yang;Zhao Qun;Li Yong;Tan Bibo;Fan Liqiao;Guo Honghai;Ding Ping’an;Tian Yuan;Du Xiayu;Yang Peigang(Department of General Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2020年第10期773-777,共5页
Chinese Journal of General Surgery
