DCE-MRI定量参数与直肠癌分化程度的关系及预测术后局部复发的价值OA
DCE-MRI Biomarkers:Correlation with Histologic Differentiation Grade and Predictive Performance for Local Recurrence in Rectal Cancer
目的:分析磁共振动态对比增强(DCE-MRI)定量参数与直肠癌分化程度的关系及预测术后局部复发的价值.方法:前瞻性纳入2021年4月至2022年4月医院收治的205例直肠癌患者,行DCE-MRI检查并测量容量转移常数(Ktrans)、速率常数(Kep)、血管外间隙容积比(Ve),通过双变量相关性Kendall's Tau-b、Cox回归、列线图模型及ROC曲线分析参数与分化程度的关系及复发预测价值.结果:Kendall's Tau-b相关性检验结果显示,Ktrans、Kep、Ve与直肠癌患者分化程度呈负相关(r=-0.739、-0.641、-0.635,P值均<0.001);局部复发组低分化、T4分期占比、Ktrans、Kep、Ve水平[75.75%(25/33)、39.39%(13/33)、(0.74±0.15)min-1、(1.51±0.26)min-1、(0.49±0.13)]高于未复发组[10.47%(18/172)、19.77%(34/172)、(0.53±0.14)min-1、(1.29±0.25)min-1、(0.41±0.12)](P<0.05);Cox回归分析结果显示,高水平Ktrans、Kep、Ve、低分化是直肠癌患者术后局部复发的危险因素(HR=82.869、7.242、16.852、3.919,P值分别为<0.001、0.005、0.043、<0.001);基于Ktrans、Kep、Ve,构建直肠癌患者术后局部复发的列线图预测模型,使用Bootstrap对列线图模型进行验证,C-index值0.909;ROC曲线显示,模型预测直肠癌患者术后局部复发的AUC为 0.909(95%置信区间:0.589～0.959,P<0.001),Cut-off值、特异度、敏感度、约登指数分别为33.80分、0.837、0.818、0.655.结论:Ktrans、Kep、Ve与直肠癌患者分化程度呈负相关,Ktrans、Kep、Ve、分化程度是直肠癌患者术后局部复发的影响因素,基于Ktrans、Kep、Ve构建的列线图模型,可有效预测直肠癌患者术后局部复发发生风险,为临床分层干预提供影像学依据.
Objective:To analyze the relationship between dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)parameters and rectal cancer differentiation grade,and their predictive value for postoperative local recurrence.Methods:A prospective study was conducted,enrolling 205 rectal cancer patients admitted to our hospital between April 2021 and April 2022.All patients underwent DCE-MRI examinations with measurement of the volume transfer constant(Ktrans),rate constant(Kep),and extracellular extravascular volume fraction(Ve).The relationships between these parameters and tumor differentiation grade were analyzed using bivariate correlation(Kendall's Tau-b),Cox regression,Nomogram modeling,and ROC curves to evaluate their predictive value for recurrence.Results:Kendall's Tau-b correlation analysis revealed significant negative correlations between Ktrans,Kep,Ve,and the differentiation degree of rectal cancer patients(r=-0.739,-0.641,-0.635,all P<0.001).The local recurrence group exhibited significantly higher proportions of poorly differentiated tumors[75.75%(25/33)vs.10.47%(18/172)]and T4 stage[39.39%(13/33)vs.19.77%(34/172)],as well as elevated levels of Ktrans[(0.74±0.15)min-1 vs.(0.53±0.14)min-1],Kep[(1.51±0.26)min-1 vs.(1.29±0.25)min-1],and Ve(0.49±0.13 vs.0.41±0.12)compared to the non-recurrence group(all P<0.05).Cox regression analysis identified high Ktrans(HR=82.869,P<0.001),high Kep(HR=7.242,P=0.005),high Ve(HR=16.852,P=0.043),and poor differentiation(HR=3.919,P<0.001)as risk factors for postoperative local recurrence in rectal cancer patients.A Nomogram prediction model for local recurrence was constructed based on Ktrans,Kep,Ve,and validated via Bootstrap resampling,demonstrating a C-index of 0.909.ROC curve analysis showed that the model achieved an AUC of 0.909(95%CI:0.589～0.959,P<0.001)in predicting postoperative local recurrence,with a cut-off value of 33.80 points,specificity of 0.837,sensitivity of 0.818,and Youden's index of 0.655.Conclusion:Ktrans,Kep,Ve are negatively correlated with the differentiation degree of rectal cancer patients,Ktrans,Kep,Ve and the degree of differentiation are influencing factors for local recurrence in rectal cancer patients after surgery.A Nomogram model based on Ktrans,Kep,Ve can effectively predict the risk of local recurrence in rectal cancer patients after surgery,providing imaging evidence for clinical stratified intervention.
郭涛;潘敦;彭万英;蒋林波;敬博
成都市第三人民医院 放射科,四川 610000成都市第三人民医院 放射科,四川 610000成都市第三人民医院 放射科,四川 610000成都市第三人民医院 放射科,四川 610000成都市第三人民医院 放射科,四川 610000
医药卫生
直肠癌磁共振动态对比增强复发分化程度
rectal cancerdynamic contrast-enhanced magnetic resonance imagingrecurrencedifferentiation grade
《影像科学与光化学》 2026 (3)
42-48,55,8
2023年四川省医学青年创新科研课题项目(Q23009).
评论