CT显示胃癌病灶体积、强化程度、病理指标与胃周淋巴结转移的相关性研究

目的分析CT显示胃癌病灶体积、增强前后强化差值、组织分化程度、免疫组化指标与胃周淋巴结转移的相关性,探讨CT征象及病理指标预测淋巴结转移的可能性。方法回顾性分析57例行胃癌根治术患者的术前CT图像,测量CT图像上病变体积、增强前后强化差值,术后评估病变的分化程度,p53、Ki-67、表皮生长因子受体（EGFR）表达水平及胃周淋巴结转移情况。按是否有胃周淋巴结转移将患者分为两组,比较转移组与无转移组在CT显示胃癌病灶体积、强化差值及病理指标方面的差异。应用多因素方差分析筛选以上参数中预测胃周淋巴结转移的独立因素,并对独立因素与转移淋巴结数量进行相关性分析,对计量预测因素用受试者工作特征（ROC）曲线选出最佳预测界值。结果 36例患者手术证实胃周淋巴结转移,余21例未见淋巴结转移。转移患者病灶的CT体积[（33.0±25.0）cm^3]显著大于无转移患者[（33.0±25.0）cm^3 vs.（6.4±4.4）cm^3,P〈0.05],但两者强化差值无显著差异。淋巴结转移患者病变的EGFR阳性率（24/36）明显高于无转移患者（9/21）（P〈0.05）,但两者Ki-67和p53指标差异无统计学意义。多因素方差分析进一步表明,仅有肿瘤体积及分化程度可作为预测淋巴结转移的独立因素（P〈0.05）,且肿瘤体积与转移淋巴结数量呈显著正相关,6 cm3为肿瘤体积对转移淋巴结的最佳预测界值（灵敏度100.0%,特异度87.5%）。低分化患者的淋巴结转移数也显著高于中分化患者（P〈0.05）。结论 CT上胃癌病灶体积及组织分化程度与胃周淋巴结转移具有一定相关性,可能有助于提高对淋巴结转移的预测。

Correlation between CT volume,enhancement, pathological indicator and perigastric lymph node metastasis of gastric cancer

Objective To analyze the correlation between CT volume, enhancement, histological differentiation, immunohistochemical indicators and perigastric lymph node metastasis of gastric cancer, and to investigate the possibility for these data to predict the metastasis of perigastric lymph node.Methods Pre-operative CT images of 57 patients who underwent radical gastrectomy were analyzed retrospectively, the volume of the cancer and degree of enhancement were measured, and after surgery, the pathological differentiation, expressions of p53, Ki-67 and epidermal growth factor receptor （EGFR） of the lesions, and perigastric lymph node metastasis were also assessed. The patients were divided into to lymph node metastasis and non-metastasis groups. CT volume of gastric cancer, degree of enhancement and pathological indicators of the two group were compared. A multiple factor variance analysis was applied on these data to select the independent factor for the prediction of perigastric lymph node metastasis. A correlation analysis was also performed between the factors and number of metastatic nodes. Moreover, an receiver operating characteristic（ROC） curve method was applied to obtain the best predictive cut-off value for the quantitative factor.Results Perigastric lymph note metastasis was confirmed in 36 patients, and the remaining 21 cases showed no metastasis. The CT volume of metastasis patients [（33.0±25.0） cm^3] was significantly higher than that of the non-metastasis patients [（6.4±4.4） cm^3] （P〈0.05）, but there was no significant difference in the degree of enhancement between the two groups. The positive rate for EGFR of the lesions from metastasis patients （24/36） was significantly higher than that from the non-metastasis patients （9/21） （P〈0.05）, but there were no significant differences in p53 and Ki-67 expression between the two groups. Only the cancer volume and differentiation were confirmed by multiple factor variance analysis to be independent factors for the prediction