基于多层螺旋CT检查的临床影像模型对进展期胃腺癌预后的预测价值

Predictive value of a clinical imaging model based on multi‑slice helical CT examination in predicting prognosis of advanced gastric adenocarcinoma

    摘要
  • 摘要:
    目的 探讨基于多层螺旋CT（MSCT）检查的临床影像模型对进展期胃腺癌预后的预测价值。
    方法 采用回顾性队列研究方法。收集2019年1月至2021年1月宁波市鄞州区第二医院收治的88例进展期胃腺癌患者的临床病理资料；男62例,女26例；年龄为（60±15）岁。患者术前均行MSCT检查。正态分布的计量资料以x±s表示；偏态分布的计量资料以M（范围）表示。计数资料以绝对数表示。单因素和多因素分析采用Logstic回归模型。采用受试者工作特征曲线分析预后预测效能,并计算曲线下面积（AUC）、灵敏度及特异度。
    结果 （1）手术与随访情况。88例患者均行胃癌根治术,术后均经病理学检查确诊为进展期胃腺癌。88例患者术后均获得随访,随访时间为41（36~48）个月,3年总生存率为69.32%。（2）影响进展期胃腺癌根治术后预后的因素分析。多因素分析结果显示：术前癌胚抗原（CEA）和壁外静脉血管侵犯（EMVI）是进展期胃腺癌患者根治术后预后的独立影响因素比值比=1.10,7.72,95%可信区间（CI）为1.01~3.82,1.42~15.42,P<0.05。（3）预测模型的构建及评价。术前CEA、EMVI预测进展期胃腺癌患者预后的效能AUC分别为0.90（95%CI为0.82~0.97）、0.80（95%CI为0.71~0.89）,灵敏度和特异度分别为85.25%、78.69%和100.00%、81.48%。根据多因素分析结果,联合术前CEA和EMVI建立预测模型,其AUC为0.93（95%CI为0.87~0.98）,灵敏度和特异度分别为86.89%和96.30%。
    结论 术前CEA及EMVI是进展期胃腺癌患者根治术后预后的独立影响因素；联合术前CEA和EMVI建立预测模型,对患者预后的预测效能良好。

     

    Abstract:
    Objective To investigate the predictive value of a clinical imaging model based on multi‑slice helical computer tomography (MSCT) examination in predicting prognosis of advanced gastric adenocarcinoma.
    Methods The retrospective cohort study was conducted. The clinicopatho-logical data of 88 patients with advanced gastric adenocarcinoma who were admitted to the Ningbo Yinzhou No.2 Hospital from January 2019 to January 2021 were collected. There were 62 males and 26 females, aged (60±15)years. All patients underwent preoperative MSCT examination. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Univariate and multivariate analyses were conducted using the Logistic regression model. The receiver opera-ting characteristic curve was used to analyze the predictive efficacy of prognosis, and the area under the curve (AUC), sensitivity, and specificity were calculated.
    Results (1) Surgical situations and follow‑up. All 88 patients underwent radical gastrectomy for gastric cancer and were diagnosed with advanced gastric adenocarcinoma through postoperative pathological examination. All 88 patients were followed up after surgery for 41(range, 36‒48)months, with a 3‑year overall survival rate of 69.32%. (2) Analysis of factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery. Results of multivariate analysis showed that preoperative carcinoembryonic antigen (CEA) and extramural venous invasion (EMVI) were independent factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery (odds ratio=1.10, 7.72, 95% confidence interval as 1.01‒3.82, 1.42‒15.42, P<0.05). (3) Construction and evaluation of predictive model. The AUC of predictive efficacy of prognosis for advanced gastric adenocarcinoma of preoperative CEA and EMVI were 0.90 (95% confidence interval as 0.82‒0.97) and 0.80 (95% confidence interval as 0.71‒0.89), respectively, with sensitivity of 85.25% and 78.69% and specificity of 100.00% and 81.48%, respec-tively. A predictive model was constructed by combining preoperative CEA and EMVI based on the results of multivariate analysis, and the AUC of the predictive model was 0.93 (95% confidence interval as 0.87‒0.98), with sensitivity and specificity of 86.89% and 96.30%.
    Conclusions CEA and EMVI are independent factors affecting the prognosis of advanced gastric adenocarcinoma after radical surgery. The predictive model constructed by combining preoperative CEA and EMVI has good predictive efficacy for patient prognosis.

     

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