晚期结直肠癌组织表观弥散系数与化疗疗效的关系

目的 探讨晚期结直肠癌组织表观弥散系数（ADC）在化疗前、后的变化及其与化疗疗效的相关性。 方法 40例晚期结直肠癌患者采用FOLFOX 4方案化疗，具体为：奥沙利铂85mg／m2静滴，d1；亚叶酸钙200mg／m2静滴，d1、d2；氟尿嘧啶（5-FU）400mg／m2静推，d1、d2；5-FU 600mg／m2持续静滴22h，d1、d2。14天为1个周期，共化疗12个周期。化疗4个周期按RECIST 1.1标准评价疗效，并将患者分为有效组（CR+PR）和无效组（SD+PD）。于化疗前、第2个周期和第4个周期化疗后行磁共振弥散加权成像扫描，并记录肿瘤组织ADC值，分析肿瘤所有目标病灶长度总和的减少情况、ADC变化值及两者的相关性。结果 40例患者中有效组22例（CR 6例，PR 16例），无效组18例（SD 11例，PD 7例）。第2个周期和第4个周期化疗后有效组的ADC值分别为（9.82±2.04）×10-4mm2／s和（10.09±1.95）×10-4mm2／s，较化疗前的（5.63±1.02）×10-4mm2／s明显升高（P=0.009，P=0.001），而无效组化疗前后的ADC值无显著差异（P=0.412，P=0.654）。有效组化疗前ADC值低于无效组（P=0.021）。有效组化疗前ADC值和第2个周期化疗后的ADC变化值分别与第4个周期化疗后所有目标病灶长度总和的减少百分比呈负相关（r=-0.681，P=0.004）和正相关（r=0.749，P=0.002）。结论 晚期结肠癌组织化疗前ADC值及化疗后早期的ADC变化值可以作为预测晚期结直肠癌对化疗敏感性和化疗早期临床疗效评价的指标。

The correlation between apparent diffusion coefficient of advanced colorectal cancer and response to chem- otherapy

Objective To investigate the changes of apparent diffusion coefficient （ADC） of advanced colorectal cancer pre- and post-chemotherapy, as well as the correlation of ADC with response to chemotherapy. Methods Forty patients with advanced colorectal cancer received FOLFOX 4 regimen： oxaliplatin 85mg/m2 iv, dl; leucovorin 200mg/m2 iv, dl, dE; fluorouracil（5-FU） 400mg/m2 bolus, dI , d2 ; 5-FU 600mg/m2, civ 22h, d1 , dE. Fourteen days was a cycle and each patient received 12 cycles. The re- sponse to chemotherapy was assessed by RECIST 1.1 criteria after 4 cycles＇ treatment. Diffusion-weighted magnetic resonance imaging scan was performed before chemotherapy and at 2nd and 4th cycles post-chemotherapy, respectively. Changes of sum of the longest diam- eter（LD） for all target lesions and tumor ADC values were recorded, and their correlation was analyzed. Results Forty patients were divided into effective group（6 cases of CR, 16 cases of PR） and non-effective group（ 11 cases of SD,7cases of PD） based on the effica- cy. In the effective group, ADC values after the 2no and 4th cycles of chemotherapy were（9. 82±2.04） ×10^-4mm^2/s and（ 10. 09±1.95） ×10^-4mm^2/s, significantly higher than（5.63±1.02）×10^-4mm^2/s before chemotherapy（ P = 0. 009, P = 0. 001 ）. While in the non-effective group, ADC values showed no significant difference （P = 0. 412）. The ADC value before chemotherapy in the effective group was（5.63±1.02）×10^-4mm^2/s, significantly lower than（8.97±1.88） ×10^-4mm^2/s in the non-effective group（P =0. 021 ）. In the effective group, the ADC value before chemotherapy showed a negative correlation with the decreased sum percentage of the LDfor all target lesions after the forth cycle of chemotherapy（ r = -0. 681 ,P = 0. 004）. The change of ADC value of tumors after the sec- ond cycle of chemotherapy showed a positive correlation with the decreased sum percentage of the LD for all target lesions after the forth cycle of chemotherapy（ r = 0. 749, P = 0. 002）. Conclusion The ADC values before chemotherapy and the changes of ADC values in the early stage after chemotherapy can predict the sensitivity of chemotherapy to advanced colorectal cancer, which can be regarded as a sensitive marker of advanced colorectal cancer at the early stage of chemotherapy.