目的 探讨弥散加权成像(DWI)检查的表观扩散系数(ADC)值与胰腺癌伴肝转移患者治疗预后的关系。方法 回顾性分析2019-10至2022-01于海军安庆医院收治的经病理学检验确诊为胰腺癌伴肝转移的96例患者,行常规MRI联合增强扫描。收集患者的相关资料,分析患者DWI的ADC值的水平,对患者进行随访,以术后12个月为随访止点,根据患者的存活情况,将患者分为存活组(n=63)和死亡组(n=33),采用多因素Logistic回归分析影响患者治疗预后的独立影响因素。结果 单因素分析结果显示,两组患者的年龄、胰肿瘤最大直径、肝转移瘤直径、肝转移瘤数目、淋巴结转移情况、肿瘤分化程度、Alb、ADC值均存在统计学差异(P<0.05),而两组患者的性别、BMI、肿瘤位置、神经侵犯情况、Hb、PLT差异并无统计学意义(P>0.05)。多因素分析结果显示,肝转移瘤数目[OR=2.702,95%CI(1.340,5.450)]、血管侵犯[OR=1.906,95%CI(1.052,3.452)]、肿瘤分化程度[OR=1.269,95%CI(1.025,1.571)]、ADC值[OR=0.422,95%CI(0.216,0.824)]均为影响胰腺癌伴肝转移患者治疗预后的独立影响因素(P<0.05),其中ADC值为独立保护性因素,其余皆为独立危险因素。结论 肝转移瘤数目、淋巴结转移、肿瘤分化程度、ADC值均为影响胰腺癌伴肝转移患者治疗预后的独立影响因素,临床可根据相应情况进行治疗方案的调整与完善。
Abstract
Objective To explore the correlation between the apparent diffusion coefficient (ADC) value of diffusion weighted imaging (DWI) and the prognosis of of pancreatic cancer patients with liver metastasis.Methods A retrospective analysis was made on 96 patients with pancreatic cancer with liver metastasis confirmed by pathology in Anqing Hospital of PLA Navy from October 2019 to January 2022, and all the patients were treated with conventional MRI combined with enhanced scanning. The relevant data of the patients were collected, the ADC value of the patients' DWI was analyzed, and the patients were followed up for 12 months. Based on the survival status of the patients, they were divided into survival group (n=63) and death group (n=33), and multivariate logistic regression analysis was used to analyze the independent influencing factors that affected the treatment prognosis of the patients.Results Univariate analysis showed that there were statistical differences in age, maximum diameter of pancreatic tumor, diameter of liver metastases, number of liver metastases, lymph node metastasis, tumor differentiation, Alb and ADC values between the two groups (P<0.05), while there was no significant difference in gender, BMI, tumor location, nerve invasion, Hb, or PLT between the two groups (P>0.05). The results of multivariate analysis showed that the number of liver metastases [OR=2.702,95%CI(1.340,5.450)], vascular invasion [OR=1.906, 95%CI (1.052, 3.452)], tumor differentiation [OR=1.269,95%CL(1.025,1.571)] and ADC value [OR=0.422, 95%CI (0.216,0.824)] were independent influencing factors on the prognosis of patients with pancreatic cancer with liver metastasis (P<0.05), in which the ADC value was an independent protective factor, and the rest were independent risk factors.Conclusions The number of liver metastases, lymph node metastasis, degree of tumor differentiation and ADC value are independent factors for the prognosis of pancreatic cancer patients with liver metastases. Clinical treatment plans can be adjusted and improved according to the corresponding situation.
关键词
胰腺癌伴肝转移 /
增强磁共振检查 /
表观扩散系数 /
预后
Key words
pancreatic cancer with liver metastasis /
gadopentetate-enhanced magnetic resonance imaging /
apparent diffusion coefficient /
prognosis
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参考文献
[1] GBD 2017 Pancreatic Cancer Collaborators. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet Gastroenterol Hepatol, 2019, 4(12):934-947.
[2] 金添强,戴朝六,徐 锋.肝胰同步手术切除与全身化疗治疗可切除胰腺癌伴肝转移患者的效果比较[J].临床肝胆病杂志,2022,38(3):622-628.
[3] Jin T, Dai C, Xu F. Surgical and local treatment of hepatic metastasis in pancreatic ductal adenocarcinoma: recent advances and future prospects[J]. Ther Adv Med Oncol, 2020,12: 1758835920933034.
[4] 李 斌,陆风旗,陈昉铭,等.基于第8版AJCC胰腺癌TNM分期的CT、MRI检查比较[J].中华肝胆外科杂志,2020,26(9):661-665.
[5] 卢增新,赵振华,王丹丹,等.局部晚期肺癌肿瘤细胞密度与磁共振扩散加权成像表观扩散系数的相关性分析[J].中华医学杂志,2018,(41):3332-3335.
[6] Park J B, Kim Y H, Kim J, et al. Radiofrequency ablation of liver metastasis in patients with locally controlled pancreatic ductal adenocarcinoma[J]. J Vasc Interv Radiol, 2012,23(5): 635-41.
[7] Siegel R L, Miller K D, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019,69(1):7-34.
[8] 中国抗癌协会胰腺癌专业委员会.中国胰腺癌综合诊治指南(2020版)[J].中华外科杂志,2021,59(2):81-100.
[9] Drouillard A, Manfredi S, Lepage C, et al. Epidemiology of pancreatic cancer[J]. Bull Cancer, 2018,105(1): 63-69.
[10] Rawla P, Thandra K C, Sunkara T. Pancreatic cancer and obesity: epidemiology, mechanism, and preventive strategies[J]. Clin J Gastroenterol, 2019,12(4): 285-291.
[11] 马晓璇,孙 鹏,李宏奇,等.磁共振ADC值定量研究在胰腺癌放疗早期疗效评价中的意义[J].医学影像学杂志,2021,31(9):1535-1538,1542.
[12] 陈 凯,杨洪吉,邓小凡,等.淋巴结转移对胰腺癌患者预后的影响[J].中华普通外科杂志,2018,33(6):452-455.
[13] Ma C, Li J, Boukar M B, et al. Optimized ROI size on ADC measurements of normal pancreas, pancreatic cancer and mass-forming chronic pancreatitis[J]. Oncotarget, 2017,8(58):99085-99092.
[14] Tahmassebi A, Wengert G J, Helbich T H, et al. Impact of machine learning with multiparametric magnetic resonance imaging of the breast for early prediction of response to neoadjuvant chemotherapy and survival outcomes in breast cancer patients[J]. Invest Radiol, 2019,54(2): 110-117.
[15] 张 悦,刘万花, 王 瑞, 等.3.0T磁共振不同b值表观扩散系数值与乳腺癌预后因子及分子分型相关性对比研究[J].磁共振成像,2018,9(6):422-426.
[16] 史旭波,黄奕彬,彭焕佳,等.1.5T MRI及其ADC值与胰腺癌临床病理特征及预后的关系[J].现代消化及介入诊疗,2021,26(4):495-500.
[17] 陆海凤,柳 勇,单 奔,等.3.0T扩散加权成像表观扩散系数在胰腺癌早期化疗疗效评估中的价值[J].南昌大学学报(医学版),2019,59(6):47-50,54.
[18] Qin L, Li A, Qu J, et al. Normalization of ADC does not improve correlation with overall survival in patients with high-grade glioma (HGG) [J]. J Neurooncol, 2018,137(2): 313-319.
[19] Wu L F, Rao S X, Xu P J, et al. Pre-TACE kurtosis of ADCtotal derived from histogram analysis for diffusion-weighted imaging is the best independent predictor of prognosis in hepatocellular carcinoma[J]. Eur Radiol, 2019,29(1):213-223.
基金
安徽省卫生健康软科学研究项目(2020WR04008)
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