血管内皮生长因子C联合多排螺旋CT诊断结直肠癌术前淋巴结转移的临床评价

目的探讨术前血清血管内皮生长因子C(sVEGF-C)水平联合多排螺旋CT(MDCT)扫描能否作为判断结直肠癌淋巴结转移的理想方法。方法 ELISA方法测定110例结直肠癌患者(结直肠癌组)及40例健康者(对照组)的sVEGF-C浓度,MDCT平扫及三期强化动态扫描判断淋巴结有无转移。结果结直肠癌组sVEGF-C浓度为(889.2±264.0)μg/L,对照组为(373.2±97.3)μg/L(P=0.000);病理诊断伴有淋巴结转移的70例结直肠癌患者sVEGF-C明显升高([996.2±247.1)μg/Lv(s701.6±173.6)μg/L,P=0.000];取临界点为996.2μg/L时,sVEGF-C诊断淋巴结转移的敏感度为57.1%,特异度为85.0%,准确度为67.3%,阳性预测值为87.0%,阴性预测值为53.0%。MDCT诊断淋巴结转移的敏感度为51.4%,特异度为70.0%,准确度为58.2%,阳性预测值为75.0%,阴性预测值为45.2%。sVEGF-C联合MDCT诊断淋巴结转移的敏感度为75.7%,特异度为92.5%,准确度81.8%,阳性预测值94.6%,阴性预测值68.5%。结论单独应用sVEGF-C或MDCT判断结直肠癌淋巴结转移效果均不理想,两者联合应用可进一步提高准确度,可作为术前判断淋巴结转移的有用指标。

Analysis of methods for diagnosis of lymph node metastasis of colorectal cancer

Objective To investigate whether serum vascular endothelial growth factor-C（sVEGF-C） and multidetector CT（MDCT） have relationships with lymph node metastasis（LNM） in colorectal cancer.Methods The sVEGFC level of 110 patients and 40 donors were examined by ELISA.Both plain and enhanced MDCT scan of abdomen were performed.Detailed pathologic findings were recorded.Results The level of sVEGFC was higher in colorectal cancer group than in control group [（889.2±264.0）μg/L vs（373.2±97.3）μg/L].As a cutoff value being 996.2μg/L,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of sVEGFC for predicating LNM were 57.1%,85.0%,67.3%,87.0%,53.0%,respectively.MDCT were used to detect the LNM,the sensitivity,specificity,accuracy,positive,negative predictive value were 51.4%,70.0%,58.2%,75.0%,45.2%,respectively.When sVEGFC associated with spiral CT were employed to diagnosis the LNM in colorectal cancer,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 75.7%,92.5%,81.8%,94.6%,68.5%,respectively.Conclusion sVEGFC associated with MDCT can be used as a preoperative methode for diagnosis of LNMin colorectal cancer.