论文部分内容阅读
目的术前新辅助治疗现在已作为中低位进展期直肠癌的标准治疗模式,对于新辅助之后患者的分期评估尤为重要并且将决定患者的下一步治疗方案。本研究将探讨磁共振成像(magnetic resonance imaging,MRI)及多层螺旋CT(multisliecs helieal CT,MSCT)在评价术前新辅助放疗或同步放化疗(neoadjuvant chemoradiotherapy,NACRT)对中晚期低位直肠癌疗效的应用价值。方法回顾性分析2011-01-01-2015-12-31新疆肿瘤医院经肠镜检查病理活检确诊的145例进展期中低位直肠癌患者,依据标准化NACRT前、后的盆腔MRI及MSCT资料分成实验组(MRI组)和对照组(MSCT组)。分析NACRT前后MRI组和MSCT组上肿瘤的体积、TN分期、环周切缘(circumferential resection margin,CRM)的改变,并与术后病理结果分别进行对照。结果 MRI组NACRT后肿瘤完全缓解4例,部分缓解23例,稳定8例,进展3例,有效率为71.1%;MSCT组NACRT后肿瘤完全缓解16例,部分缓解63例,稳定17例,进展11例,有效率为72.0%,两组有效率比较,差异无统计学意义,χ~2=0.011,P>0.05。MRI组术前T分期、CRM受侵情况的判断与术后病理结果一致性较好(Kappa=0.546、0.685),而N分期与术后病理结果一致性较差(Kappa=0.333);MSCT组术前T分期、CRM受累情况的判断与术后病理结果一致性较好(Kappa=0.503、0.650),而N分期与术后病理结果一致性较差(Kappa=0.299)。两组影像学分期分别与术后病理结果进行对照比较:(1)T分期,两组比较差异无统计学意义,χ~2=1.287,P>0.05;(2)N分期,两组比较差异无统计学意义,χ~2=0.154,P>0.05;(3)CRM受累情况,两组比较差异无统计学意义,χ~2=0.344,P>0.05。结论 NACRT可以有效缩小肿瘤的体积,降低肿瘤分期,但对CRM受侵情况并无明显改善。MRI和MSCT可以较为准确的判断肿瘤浸润程度,但对于淋巴结转移的检测准确性较差,MRI的一致性优于MSCT,但准确性无明显差异。
Preoperative neoadjuvant therapy is now the standard treatment for advanced low-grade advanced rectal cancer and is particularly important for staging assessment of patients after neoadjuvant and will determine the patient’s next treatment regimen. This study was to investigate the effect of preoperative neoadjuvant chemoradiotherapy (NACRT) on magnetic resonance imaging (MRI) and multi-slice helical CT (MSCT) The application value. Methods Retrospective analysis 2011-01-01-2015-12-31 Xinjiang Tumor Hospital 145 cases of advanced low and medium rectal cancer diagnosed by colonoscopy biopsy were divided into two groups according to the data of pelvic MRI before and after standardized NACRT (MRI group) and control group (MSCT group). The changes of tumor volume, TN stage and circumferential resection margin (CRM) in MRI group and MSCT group before and after NACRT were analyzed and compared with postoperative pathological results respectively. Results In the MRI group, 4 cases were completely relieved of tumor after NACRT, 23 cases were partially relieved, 8 cases were stable and 3 cases were improved. The effective rate was 71.1%. In the MSCT group, 16 cases were completely relieved of tumor after NACRT, 63 cases were partially relieved, and 17 cases were stable In 11 cases, the effective rate was 72.0%. There was no significant difference in the effective rates between the two groups (χ ~ 2 = 0.011, P> 0.05). MRI preoperative T stage, CRM invaded the judge and postoperative pathology better consistency (Kappa = 0.546, 0.685), while the N staging and postoperative pathological consistency was poor (Kappa = 0.333); MSCT group The preoperative T stage and CRM involvement were consistent with postoperative pathological findings (Kappa = 0.503, 0.650), while the N staging was not consistent with postoperative pathology (Kappa = 0.299). There was no significant difference between the two groups (χ ~ 2 = 1.287, P> 0.05); (2) N stage, the difference between the two groups was statistically significant Χ ~ 2 = 0.154, P> 0.05. (3) There was no significant difference in CRM involvement between the two groups (χ ~ 2 = 0.344, P> 0.05). Conclusion NACRT can effectively reduce the size of the tumor and reduce the tumor stage, but no significant improvement of the CRM invasion. MRI and MSCT can be more accurate to determine the degree of tumor invasion, but the detection accuracy for lymph node metastasis is poor, MRI consistency is better than MSCT, but no significant difference in accuracy.