摘要
目的探讨磁共振小视野扩散加权成像(rFOV-DWI)在局部进展期胰腺癌临床疗效预测中的价值。方法本前瞻性研究对象为2015年1月至2017年7月在海军军医大学第一附属医院诊治的41例局部进展期胰腺癌患者。患者均签署知情同意书,符合医学伦理学规定。其中男28例,女13例;年龄44~80岁,中位年龄为64岁。41例均接受放疗,32例口服化疗药替吉奥。治疗前1周内接受3.0T MRI检查,检测病灶信号强度。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型筛选预后影响因素。采用预测误差曲线分析预测效能,评价指标为综合Brier评分(IBS)和C-index。结果局部进展期胰腺癌典型层面在3.0T rFOV-DWI图像表现为T1WI上呈稍低信号,T2WI上呈稍高信号,动脉期呈低强化,rFOV-DWI上呈高信号。感兴趣区域的信号强度中位数为537(357~943)。患者中位总体生存期、无瘤生存期分别为11.7、7.2个月。生存分析显示,胰体尾部癌无进展生存明显优于胰头部癌(χ^(2)=5.165,P<0.05)。Cox多因素回归分析显示,信号强度及口服化疗药替吉奥均为患者总体生存的独立保护因素(HR=0.995,0.161;P<0.05);两者联合对总体生存预测的效能最高,IBS为0.152,C-index为0.673。结论局部进展期胰腺癌患者磁共振rFOV-DWI信号强度越强,口服化疗药替吉奥对患者总体生存越有益。
Objective To evaluate the effect of reduced field-of-view diffusion-weighted imaging(rFOV-DWI)in predicting the clinical efficacy of locally advanced pancreatic cancer.Methods 41 patients with locally advanced pancreatic cancer treated in the First Affiliated Hospital of Naval Medical University from January 2015 to July 2017 were enrolled in this prospective study.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,28 patients were male and 13 female,aged from 44 to 80 with a median age of 64 years.All 41 patients received radiotherapy,and 32 cases were treated with orally chemotherapeutic drug S-1.3.0T MRI was performed within 1 week before treatment to detect the signal intensity of lesions.Survival analysis was conducted by Kaplan-Meier method and Log-rank test.Prognostic factors were screened by Cox proportional hazards regression model.The prediction efficiency was analyzed using prediction error curve.The evaluation indexes included integrated Brier score(IBS)and C-index.Results In 3.0T rFOV-DWI,typical planes of the locally advanced pancreatic cancer were manifested with slightly low signal intensity on T1WI,slightly high signal intensity on T2WI,low enhancement in the arterial stage and high signal intensity on rFOV-DWI.The median signal intensity of the region of interest was 537(357-943).The median overall survival and disease-free survival were 11.7 and 7.2 months,respectively.Survival analysis demonstrated that the progression-free survival of patients with pancreatic tail cancer was significantly better than that of their counterparts with pancreatic head cancer(χ^(2)=5.165,P<0.05).Cox regression model showed that signal intensity and oral intake of S-1 were the independent protective factors for the overall survival of patients(HR=0.995,0.161;P<0.05).The combination of these two yielded the highest efficiency in predicting the overall survival,with an IBS of 0.152 and C-index of 0.673.Conclusions The stronger the signal intensity of
作者
张瑜
郑楷炼
李欲晓
Zhang Yu;Zheng Kailian;Li Yuxiao(Department of Radiotherapy,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Hepatobiliary and Pancreatic Surgery;Department of Radiology,the First Affiliated Hospital of Naval Medical University,Shanghai 200438,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2022年第2期139-143,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
申康中心临床“五新”创新研发项目(SHDC2020CR3087B)
长海医院234学科攀峰计划(2019YPT004)。
关键词
胰腺肿瘤
磁共振成像
扩散加权成像
预后
Pancreatic neoplasms
Magnetic resonance imaging
Diffusion-weighted imaging
Prognosis
