进展期胃癌CT征象与其临床病理特征的关系

目的:探讨进展期胃癌CT征象与其临床病理特征间的关系。方法:对91例经活检证实的胃癌病人行术前多层螺旋CT(MSCT)检查,分析肿瘤之CT征象(强化程度、瘤周低密度带厚度、CT轴位图像上肿瘤最大径及厚度,以及临床TNM分期)与其临床病理特征的关系。结果:胃癌强化程度与淋巴结转移(P<0.01)、TNM分期(P<0.05)、组织学类型(P<0.001)及性别(P<0.001)均密切相关;而与浸润深度、远处转移、病人年龄及肿瘤部位无关。瘤周低密度带厚度与淋巴结转移(P<0.01)、组织学类型(P<0.001)及肿瘤部位(P<0.05)均密切相关。同时,胃癌强化程度与瘤周低密度带厚度呈线性相关(r=0.366,P<0.001)。CT轴位图像上肿瘤最大径与浸润深度(P<0.05)、淋巴结转移(P<0.05)、TNM分期(P<0.05)、组织学类型(P<0.01)及性别(P<0.05)均密切相关,肿瘤厚度与淋巴结转移(P<0.05)和TNM分期(P<0.05)均密切相关。受试者工作特征(ROC)分析显示,肿瘤强化程度和瘤周低密度带厚度对胃癌组织学类型判断的准确率均较高ROC曲线下面积(Az)分别为0.74和0.80],且瘤周低密度带厚度对淋巴结转移判断的准确率亦较高(Az=0.74)。胃癌CT分期与病理分期的一致性良好(其中T、N、M和TNM分期的Kappa值分别为0.57、0.45、0.55和0.43)。结论:多层螺旋CT对进展期胃癌术前分期的准确性较高。同时,肿瘤强化程度和瘤周低密度带厚度有助于对胃癌组织学类型的判断,且瘤周低密度带厚度还有助于对淋巴结转移的判断。

The relationship between CT features and clinicopathologic parameters in advanced gastric carcinoma

Objective To investigate the relationship between the CT features and clinicopathologic parameters in advanced gastric carcinoma. Methods Multi-slice spiral CT (MSCT) was performed preoperatively in 91 patients with gas- tric carcinoma confirmed by biopsy, and the correlation between CT features (degree of enhancement, thickness of peritu- mor low-density band, maximal diameter and thickness of tumor in the axial CT image, and clinical TNM staging) and clinicopathologic parameters of gastric carcinoma was analyzed. Results The enhancement degree of tumor was closely re- lated to lymph node metastasis (P<0.01), TNM staging (P<0.05), histologic type (P<0.001) and gender (P<0.001). However, there was no significant correlation between the degree of enhancement and depth of invasion, distant metstasis, age of patient and tumor location. The thickness of peritumor low-density band was associated with lymph node metastasis (P< 0.01), histologic type (P<0.001) and tumor location (P<0.05). In addition, a linear correlation was elucidated by logistic re- gression between the enhancement degree of gastric carcinoma and the thickness of peritumor low-density band (r=0.366, P<0.001). The maximal diameter of tumor in the axial CT image was correlated with depth of invasion (P<0.05), lymph node metastasis (P<0.05), TNM staging (P<0.05), histologic type (P<0.01) and gender of patient (P<0.05). The thickness of tumor in the axial CT image was correlated with lymph node metastasis (P<0.05) and TNM staging (P<0.05). Receiver op- erating characteristic analysis (ROC) showed that the accuracy of the enhancement degree of tumor and thickness of peri- tumor low-density band in determining the histologic type of gastric carcinoma was relatively high area under ROC curve (Az) was 0.74 and 0.80, respectively], and the accuracy of the thickness of peritumor low-density band in determining lymph node metastasis was also high (Az=0.74). The degree of agreement between the CT staging and the histopathological staging were moderate (the Kappa value for T, N, M and TNM staging was 0.57, 0.45, 0.55, and 0.43, respectively). Conclusions The accuracy of MSCT in preoperative staging of advanced gastric carcinoma is relatively high. In addition, the enhancement degree of tumor and thickness of peritumor low-density band are useful in determining not only the histo- logic type of gastric carcinoma, but also the extent of lymph node metastasis.