平衡对比增强 CT 测定细胞外容积分数预测局部晚期直肠癌新辅助放化疗病理完全缓解的价值。
Extracellular volume fraction determined by equilibrium contrast-enhanced CT for the prediction of the pathological complete response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer.
机构信息
Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China.
Cancer Radiotherapy Center, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, 400030, People's Republic of China.
出版信息
Eur Radiol. 2023 Jun;33(6):4042-4051. doi: 10.1007/s00330-022-09307-z. Epub 2022 Dec 3.
OBJECTIVES
To determine the extracellular volume (ECV) fraction derived from equilibrium contrast-enhanced CT for predicting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC).
METHODS
The ECV fraction before NCRT (ECV and/or ECV after NCRT (ECV) of rectal tumors was assessed, and ECV was calculated as ECV - ECV. The histopathologic tumor regression grading (TRG) was assessed. pCR (TRG 0 grade) was defined as the absence of viable tumor cells in the primary tumor and lymph nodes. Demographic and clinicopathological characteristics and ECV fraction were compared between the pCR and non-pCR groups. A mixed model was constructed by logistic regression. The performance for predicting pCR was assessed with the area under the receiver-operator curve (AUC). The AUCs of the different methods were compared by the method proposed by DeLong et al. RESULTS: Seventy-five patients were included; 17 achieved pCR, and 58 achieved non-pCR. The ECV (17.05 ± 2.36% vs. 29.94 ± 1.20%; p < 0.001) and ECV (- 17.01 ± 3.01% vs. 0.44 ± 1.45%; p < 0.001) values in the pCR group were significantly lower than those in the non-pCR group. The mixed model that combined ECV with ECV achieved an AUC of 0.92 (95% confidence interval (CI) = 0.81-0.98), which was higher than that of ECV (AUC, 0.91 (95% CI = 0.80-0.97); p = 0.60) or ECV (AUC, 0.90 (95% CI = 0.79-0.97); p = 0.61).
CONCLUSIONS
ECV and ECV determined by using equilibrium contrast-enhanced CT were useful in distinguishing between pCR and non-pCR patients with LARC who received NCRT.
KEY POINTS
• ECV and ECV (ECV - ECV) differed significantly between the non-pCR and pCR groups. • ECV cannot be used to predict the efficacy of neoadjuvant chemoradiotherapy. • ECV combined with ECV had the best performance with an AUC of 0.92 for predicting pCR after NCRT in LARC.
目的
通过对比剂平衡增强 CT 计算细胞外容积（ECV）分数，评估其在预测局部进展期直肠癌（LARC）新辅助放化疗（NCRT）后病理完全缓解（pCR）中的作用。
方法
术前（NCRT 前）、术后（NCRT 后）直肠肿瘤的 ECV 分数进行评估，ECV 计算方法为 ECV-NCRT 后的 ECV。采用组织病理肿瘤消退分级（TRG）评估。pCR（TRG0 级）定义为原发肿瘤和淋巴结中无存活肿瘤细胞。比较 pCR 组与非 pCR 组之间的人口统计学和临床病理特征和 ECV 分数。采用逻辑回归构建混合模型。通过受试者工作特征曲线（AUC）下面积评估预测 pCR 的性能。采用 DeLong 等提出的方法比较不同方法的 AUC。
结果
共纳入 75 例患者，其中 17 例达到 pCR，58 例未达到 pCR。pCR 组 ECV（17.05±2.36%比 29.94±1.20%；p<0.001）和 ECV（-17.01±3.01%比 0.44±1.45%；p<0.001）值明显低于非 pCR 组。结合 ECV 和 ECV 的混合模型 AUC 为 0.92（95%置信区间（CI）=0.81-0.98），高于 ECV（AUC，0.91（95%CI=0.80-0.97）；p=0.60）或 ECV（AUC，0.90（95%CI=0.79-0.97）；p=0.61）。
结论
使用平衡对比增强 CT 确定的 ECV 和 ECV 有助于区分接受 NCRT 的 LARC 患者中 pCR 与非 pCR。
关键点
•非 pCR 组与 pCR 组的 ECV 和 ECV（ECV-NCRT 后的 ECV）差异有统计学意义。
•ECV 不能用于预测新辅助放化疗的疗效。
•ECV 与 ECV 结合的 AUC 最佳，为 0.92，用于预测 LARC 患者 NCRT 后的 pCR。
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