摘要
目的:探讨术前CT图像评估肿瘤生长模式(CT-TGP)对非转移性结肠癌术后复发转移的预测价值。方法:回顾性分析来自两个独立研究中心共426例(中心1,n=204;中心2,n=222)经手术切除治疗的非转移性结肠癌患者资料。通过术前CT图像评估CT-TGP和原发肿瘤分期(CT-T分期)。根据肿瘤外缘征象,将CT-TGP分为G1(肿瘤外缘光滑清晰)或G2(肿瘤外缘模糊伴不规则突起);根据肿瘤浸润超出肠壁外缘轮廓的深度,将CT-T分期分为T1/2-T3ab(≤5 mm)或T3cd-T4(>5 mm)。采用Cox回归分析评估CT-TGP、CT-T分期与结肠癌术后复发转移的关系,用Kaplan-Meier曲线比较不同CT-TGP或CT-T分期组间无病生存期(DFS)的差异。采用C指数量化CT-TGP和CT-T分期对预后的评估效能。采用Cohen's kappa和Light's kappa量化CT-TGP和CT-T分期的观察者间一致性。结果:在中心1与中心2中,CT-TGP均与患者DFS显著相关,CT-TGP在中心1和中心2的风险比分别为2.48(95%CI为1.32~4.64,P<0.01,C指数为0.61)和2.59(95%CI为1.50~4.48,P<0.001,C指数为0.62)。CT-T分期仅在中心1中与患者DFS显著相关(风险比为2.65;95%CI为1.32~5.34,P<0.01,C指数为0.60)。在中心2中,T3cd-T4期与T1/2-T3ab期患者DFS差异无统计学意义(风险比为1.54;95%CI为0.83~2.83,P=0.17,C指数为0.55)。此外,CT-TGP的观察者间一致性优于CT-T分期(Light's kappa 0.67与0.52)。结论:CT-TGP与非转移性结肠癌患者的术后复发转移风险相关,且在不同中心均有较好的预后评估价值。相比于CT-T分期,CT-TGP具有更高的观察者间的一致性。因此,认为CT-TGP是一个有效的非转移性结肠癌预后评估的生物标志物,可用于患者的风险分层分析。
Objective:To investigate the predictive value of tumor growth patterns on computed tomography(CT-TGP)for the postoperative recurrence and metastasis in non-metastatic colon cancer.Methods:Data of 426 patients with non-metastatic colon cancer who underwent surgical resection was retrospectively analyzed from two independent research centers(center1,n=204;center2,n=222).Preoperative CT images were analyzed to assess CT-TGP and tumor(CT-T)stage of enrolled patients.According to the signs of tumor outer margin,CT-TGP was classified as G1(with smooth and clear tumor outer margin)or G2(tumor outer margin was indistinct with irregular protrusions).CT-T stage was categorized into T1/2-T3ab(≤5 mm)or T3cd-T4(>5 mm)based on the depth of tumor infiltration beyond the outer contour of the intestinal wall.Cox regression analysis was used to evaluate the association of the risk of recurrence and metastasis in colon cancer with CT-TGP and CT-T stages.Disease-free survival(DFS)of different CT-TGP or CT-T stage was compared using Kaplan-Meier survival curves.The prognostic value of CT-TGP and CT-T stage was quantified using Harrell's concordance index(C-index).The interobserver agreements of CT-TGP and CT-T stage were quantified utilizing Cohen's kappa and Light's kappa.Results:CT-TGP was identified significantly associated with DFS in both center 1and center 2.The hazard ratios(HRs)of CT-TGP in center 1 and center 2 were 2.48(95%confidence interval[CI]1.32~4.64,P<0.01,C-index 0.61)and 2.59(95%CI 1.50~4.48,P<0.001,C-index 0.62)respectively.CT-T staging was only found significantly prognostic for DFS in center 1(HR 2.65,95%CI,1.32~5.34,P<0.01,C-index 0.60).In center 2,there was no statistically significant difference in DFS between T3cd-T4 stage and T1/2-T3ab stage patients(HR 1.54,95%CI,0.83~2.83,P=0.17,C-index 0.55).Additionally,CT-TGP demonstrated better interobserver consistency than CT-T stage(Light's kappa 0.67 vs 0.52).Conclusion:CT-TGP was associated with postoperative recurrence and metastasis in patients with non-metast
作者
胡庆如
叶蕴锐
黄海涛
许伟雄
赵可
崔艳芬
刘再毅
HU Qingru;YE Yunrui;HUANG Haitao;XU Weixiong;ZHAO Ke;CUI Yanfen;LIU Zaiyi(Department of Radiology,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,Guangdong,China;Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Guangzhou 510080,Guangdong,China;School of Medicine,South China University of Technology,Guangzhou 510641,Guangdong,China;Department of Radiology,Shanxi Cancer Hospital,Taiyuan 030013,Shanxi,China;Guangdong Cardiovascular Institute,Guangzhou 510080,Guangdong,China)
出处
《暨南大学学报（自然科学与医学版）》
CAS
北大核心
2024年第2期140-149,共10页
Journal of Jinan University(Natural Science & Medicine Edition)
基金
国家杰出青年科学基金项目(81925023)
国家自然科学基金青年科学基金项目(82202267)
国家自然科学基金区域创新与发展联合基金项目(U22A20345)。
关键词
结肠癌
计算机断层扫描
预测
复发转移
colon cancer
computed tomography
predict
recurrence and metastasis
