| 进展期直肠癌新辅助放化疗疗效评估模型的建立及评价:基于MRI和网状蛋白1C |
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| 作者姓名： | 董健 李垣婕 谢宗源 程亮 李兴 赵振伟 |
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| 作者单位： | 1.开滦总医院林西医院普外科，河北 唐山 0631002.华北理工大学附属医院磁共振室，河北 唐山 063000 |
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| 基金项目： | 河北省医学科学研究重点课题20181454河北省科技计划项162777139 |
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| 摘 要： | 目的建立基于MRI和网状蛋白1C（RTN-1C）的进展期直肠癌新辅助放化疗疗效评估模型并评价该模型的效能。方法选取2018年8月~2020年11月在开滦总医院林西医院就诊的134例进展期直肠癌患者作为研究对象，并根据是否达到病理学完全缓解将其分为2组:完全缓解组（n=39）和未完全缓解组（n=95）。用Ficoll密度梯度分离法获取外周血中单个核细胞，用蛋白质免疫印迹法检测单个核细胞中RTN-1C表达量。用Logistic回归分析进展期直肠癌新辅助放化疗疗效的风险因素，并构建上述风险因素的列线图回归模型；用ROC曲线、校准曲线和决策曲线分析评价预测模型的价值。结果完全缓解组的容积转运常数（Ktrans）、血管外细胞外间隙容积比（Ve）、回流速率常数（Kep）和RTN-1C相对表达量均高于未完全缓解组（P < 0.05）；表观弥散系数（ADC）低于未完全缓解组（0.88±0.05）×10-3 mm2/s vs（0.92±0.05）×10-3 mm2/s, P < 0.05]。Logistic回归分析结果显示T4期和高ADC值是进展期直肠癌新辅助放化疗疗效独立危险因素（P < 0.05），高Ktrans值、高Ve值和高RTN-1C相对表达量是进展期直肠癌新辅助放化疗疗效的独立保护因素（P < 0.05）。当阈值概率在0.39%~0.42%，0.75%~0.80%和0.86%~0.88%时，模型B评价进展期直肠癌新辅助放化疗疗效的净收益高于模型A；当阈值概率在其他范围时，模型A评价进展期直肠癌新辅助放化疗疗效的净收益高于模型B。结论基于MRI和RTN-1C构建的模型A对进展期直肠癌新辅助放化疗疗效有较高的区分度、校准度和临床应用价值，可辅助临床做出更好决策。
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| 关 键 词： | 进展期直肠癌 新辅助放化疗 磁共振功能成像 网状蛋白1C 疗效评估模型 |
| 收稿时间： | 2021-04-11 |
Establishment and evaluation of neoadjuvant radiotherapy and chemotherapy efficacy evaluation model for advanced rectal cancer based on MRI and RTN-1C |
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| Authors: | Jian DONG Yuanjie LI Zongyuan XIE Liang CHENG Xing LI Zhenwei ZHAO |
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| Affiliation: | 1.Department of General Surgery, Linxi Hospital, Kailuan General Hospital, Tangshan 063100, China2.Magnetic Resonance Room, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China |
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| Abstract: | ObjectiveTo establish a model for evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy for advanced rectal cancer based on MRI and reticulin 1C (RTN-1C) and evaluate the efficacy of the model.MethodsA total of 134 patients with advanced rectal cancer treated in Linxi Hospital of Kailuan General Hospital from August 2018 to November 2020 were selected as subjects. According to whether they achieved pathological complete response, they were divided into two groups : complete remission group (n=39) and incomplete remission group (n=95). The mononuclear cells in peripheral blood were obtained by Ficoll density gradient separation method, and the expression of RTN-1C in mononuclear cells was detected by Western blot. Logistic regression was used to analyze the risk factors of neoadjuvant radiotherapy and chemotherapy efficacy in advanced rectal cancer, and the nomogram regression model of these risk factors was established. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis were used to evaluate the value of the prediction model.ResultsThe volume transfer constant (Ktrans), extravascular extracellular space volume ratio (Ve), reflux rate constant (Kep) and relative expression of RTN-1C in the complete remission group were all higher than those in the incomplete remission group; apparent diffusion coefficient (ADC) in the complete remission group was lower than that in the incomplete remission group (P < 0.05). The results of logistic regression analysis showed that T4 stage and high ADC value were independent risk factors for the efficacy of neoadjuvant radiotherapy and chemotherapy in advanced rectal cancer (P < 0.05). High Ktrans, high Ve value and high relative expression of RTN-1C were independent protective factors for the efficacy of neoadjuvant radiotherapy and chemotherapy in advanced rectal cancer (P < 0.05). When the threshold probability was 0.39%-0.42%, 0.75%-0.80% and 0.86%-0.88%, the net benefit of model B evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy in advanced rectal cancer was higher than that of model A. When the threshold probability was in other ranges, the net benefit of model A evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy in advanced rectal cancer was higher than that of model B.ConclusionModel A based on MRI and RTN-1C have a high degree of discrimination, calibration and clinical application value for the efficacy of neoadjuvant radiotherapy and chemotherapy in advanced rectal cancer, which can assist clinical decision-making. |
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