摘要
目的探讨弥漫浸润型(BorrmannⅣ型)胃癌原发灶CT征象评价隐匿性腹膜转移(OPM)的效能。方法回顾性连续收集2014年3月至2021年3月北京大学肿瘤医院收治的101例局部进展期BorrmannⅣ型胃癌患者。根据术前CT和腹腔镜探查/灌洗细胞学检查结果,将患者分为OPM组(53例)和非OPM组(48例)。记录患者病理结果,包括组织学分化程度和Lauren分型。对术前CT进行分析,评估指标包括肿瘤中心位置、累及分区数、累及方位、黏膜宽带征、分层强化模式、浆膜侵犯、周围脂肪间隙浸润和肿大淋巴结,测量原发肿瘤最大厚度、肿瘤平均CT值(动脉期、静脉期和延迟期)、静脉期与动脉期CT值差值、延迟期与静脉期CT值差值及肿瘤强化曲线类型。采用Mann-Whitney U检验或χ2检验比较组间病理和CT征象的差异。采用多因素logistic回归筛选独立预测因子并建立列线图,以受试者操作特征曲线评估列线图预测OPM的效能,应用Hosmer-Lemeshow检验模型拟合优度。结果OPM和非OPM组间肿瘤累及分区数、黏膜宽带征、分层强化、浆膜侵犯、周围脂肪间隙浸润、强化曲线模式和组织学分化程度差异有统计学意义(P<0.05)。其中组织学分化程度(OR=0.19,P=0.033)、三分层强化(OR=7.02,P=0.005)、浆膜侵犯(OR=14.27,P<0.001)为OPM的独立风险因素,所建立的列线图预测OPM的曲线下面积为0.826(95%CI 0.745~0.908),灵敏度为0.566,特异度为0.938,拟合优度Hosmer-Lemeshow检验结果表明列线图预测的OPM风险与实际风险之间具有良好的一致性(P=0.525),。结论BorrmannⅣ型胃癌OPM患者原发癌灶CT征象有一定特征性,基于组织分化程度、分层强化和浆膜侵犯的诊断模型评价OPM具有较高的效能。
Objective To investigate the efficacy of CT imaging features in evaluating occult peritoneal metastasis(OPM)of diffuse infiltrating gastric cancer(Borrmann TypeⅣ).Methods Totally 101 patients with locally advanced Borrmann typeⅣgastric cancer were retrospectively collected who were admitted to Peking University Cancer Hospital from March 2014 to March 2021.The patients were divided into OPM group(53 cases)and the non-OPM group(48 cases)according to the results of preoperative CT and laparoscopic exploration/peritoneal cytology examination.The pathological examination results were recorded,including the degree of histological differentiation and Lauren classification.The evaluation indicators included the tumor center position,the number of tumor-occupied portions,involved orientation,mucosal broadband sign,stratified enhancement,serosa invasion,increased density of peripheral fat tissue,and enlarged lymph nodes.The maximum thickness of the primary tumor,average CT value of the primary tumor(arterial phase,venous phase,and delayed phase),difference between venous phase and arterial phase,difference between delayed phase and venous phase,and pattern of the enhanced curve were recorded.The Mann-Whitney U or Chi-square test was used to compare the differences of pathological and CT features between two groups.The multivariate logistic regression was used to screen independent predictors and establish a nomogram.The receiver operating characteristic curve was used to evaluate the performance of the nomogram in predicting OPM,and the Hosmer-Lemeshow test was used to test the model′s goodness of fit.Results There was statistical significance in the seven indicators between the OPM and non-OPM groups,including tumor-occupied portions of stomach,mucosal broadband sign,stratified enhancement,serosa invasion,increased density of peripheral fat tissue,the enhanced curve pattern and the degree of histological differentiation(P<0.05).Among them,the degree of histological differentiation(OR=0.19,P=0.033),stratified enhanc
作者
何蒙
李佳铮
刘一婷
李晓婷
魏义圆
李浙民
孙应实
李子禹
唐磊
He Meng;Li Jiazheng;Liu Yiting;Li Xiaoting;Wei Yiyuan;Li Zhemin;Sun Yingshi;Li Ziyu;Tang Lei(Department of Radiology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China;Center of Gastrointestinal Surgery,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2022年第12期1318-1325,共8页
Chinese Journal of Radiology
基金
北京市自然科学基金(Z180001)
国家自然科学基金(91959205)。
