摘要
目的探究3.0T MRI多模态技术联合血清切除修复交叉互补基因1(ERCC1)评估局部进展期直肠癌(LARC)新辅助治疗转归的临床价值。方法选取2020年1月~2022年10月我院170例LARC患者,按7∶3比例将患者随机分为建模人群(119例)、验证人群(51例)。所有患者均行新辅助治疗,治疗前均行3.0T MRI多模态技术扫描和血清ERCC1 mRNA检测。新辅助治疗8周后行手术治疗,取术中病灶组织评估肿瘤退缩分级,比较不同肿瘤退缩分级患者治疗前多模态MRI定量参数[容积转移常数(K^(trans))、组织间隙血浆速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e))、表观扩散系数(ADC)]、血清ERCC1 mRNA表达水平,比较治疗前不同临床分期患者MRI定量参数、血清ERCC1 mRNA表达水平,分析各指标与治疗前临床分期、治疗后肿瘤退缩分级的相关性,通过受试者工作特征曲线(ROC)、临床决策曲线(DCA)评价各指标预测肿瘤退缩分级的价值。结果非病理完全缓解(pCR)患者治疗前K^(trans)、V_(e)、K_(ep)、血清ERCC1 mRNA表达水平高于pCR患者,ADC低于pCR患者(P<0.05);Ⅱ期患者K^(trans)、V_(e)、K_(ep)、血清ERCC1 mRNA表达水平低于Ⅲ期患者,ADC高于Ⅲ期患者(P<0.05);K^(trans)、V_(e)、K_(ep)、血清ERCC1 mRNA表达水平与临床分期呈正相关,与肿瘤退缩分级呈负相关,ADC与临床分期呈负相关,与肿瘤退缩分级呈正相关(P<0.05);建模人群中,治疗前MRI定量参数、血清ERCC1 mRNA联合预测患者肿瘤退缩分级为pCR的AUC最大;验证人群中,MRI定量参数、血清ERCC1 mRNA联合预测具有明显正向净收益。结论MRI定量参数、血清ERCC1与患者临床分期、肿瘤退缩分级有关,且以上指标联合预测肿瘤退缩分级为pCR方面具有较好预测价值和临床适用性。
Objective To explore the clinical value of 3.0T MRI multimodal technique combined with serectomy repair Cross complementary gene 1(ERCC1)in evaluating the outcome of neoadjuvant therapy for locally advanced rectal cancer(LARC).Methods 170 LARC patients in our hospital from January 2020 to October 2022 were selected and randomly divided into modeling population(119 cases)and verification population(51 cases)according to a ratio of 7:3.All patients received neoadjuvant therapy,3.0T MRI multimodal technology scanning and serum ERCC1 mRNA detection before treatment.After 8 weeks of neoadjuvant therapy,surgical treatment was performed,and intraoperative lesion tissue was taken to evaluate tumor regression grade.The quantitative parameters of multi-modal MRI,such as volume transfer constant(K^(trans)),interstitial plasma rate constant(K_(ep)),extravascular extracellular space volume fraction(V_(e)),apparent diffusion coefficient(ADC),and serum ERCC1 mRNA expression level were compared before treatment in patients with different tumor regression grade.The quantitative MRI parameters and serum ERCC1 mRNA expression levels of patients with different clinical stages before treatment were compared,and the correlation between each indicator and the clinical stage before treatment and the tumor regression grade after treatment was analyzed.The value of each indicator in predicting tumor regression grade was evaluated by receiver operating characteristic curve(ROC)and clinical decision curve(DCA).Results The mRNA expression levels of K^(trans),V_(e),K_(ep)and ERCC1 in patients with nonpathological complete response(pCR)before treatment were higher than those in pCR patients,and ADC was lower than those in pCR patients(P<0.05).The mRNA expression levels of K^(trans),V_(e),K_(ep)and ERCC1 in stageⅡpatients were lower than those in stageⅢpatients,and ADC was higher than those in stageⅢpatients(P<0.05).The mRNA expression levels of K^(trans),V_(e),K_(ep)and serum ERCC1 were positively correlated with clinical stage and negatively correlated with tumor regression grade,while ADC was negatively correlated with clinical stage and positively correlated with tumor regression grade(P<0.05).In the modeling population,the combination of MRI quantitative parameters and serum ERCC1 mRNA before treatment had the largest AUC in predicting the tumor regression grade to pCR.The combined prediction of MRI quantitative parameters and serum ERCC1 mRNA showed a significant positive net benefit in the population.Conclusion Quantitative MRI parameters and serum ERCC1 are related to clinical stage and tumor regression grade of patients,and the combination of these indicators has good predictive value and clinical applicability in predicting tumor regression grade to pCR.
作者
王兴林
郭志伟
黄建儒
敬杰
李海青
Wang Xing-Lin;GUO Zhi-Wei;HUANG Jian-Ru;Jing Jie;LI Hai-Qing(Department of Radiology,Nanchong Central Hospital,Nanchong 637000,Sichuan Province,China)
出处
《中国CT和MRI杂志》
2024年第4期133-136,共4页
Chinese Journal of CT and MRI
基金
四川省医学科研青年创新课题计划(Q20043)。
