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目的探索增强多排螺旋CT(ce MDCT)诊断结肠癌壁外血管侵犯(EMVI)预测病人3年无病生存(DFS)的价值。方法收集北京大学人民医院胃肠外科2009年2月至2013年12月间接受根治性手术切除并经病理学检查证实的90例原发性结肠癌病人的临床病理资料及术前影像学资料。根据术前ce MDCT影像特征确定结肠癌EMVI阳性为结肠癌块直接侵犯至结肠壁外血管腔内。Kaplan-Meier法比较结肠癌病人3年DFS差异;Cox比例风险模型单因素、多因素分析结肠癌病人3年DFS的相关因素及独立预测因素;卡方检验比较结肠癌病人的复发转移发生率。结果根据美国癌症联合委员会(AJCC)的标准,经病理诊断为Ⅲ期的90例结肠癌病人纳入本回顾性研究。Cox多因素模型分析发现,ce MDCT诊断EMVI阳性(HR=3.266,95%CI 1.648~7.173,P=0.003)和术前血清CA19-9≥37 k U/L(HR=2.229,95%CI 1.040~4.776,P=0.039)是预测Ⅲ期结肠癌病人3年DFS的独立危险因素。EMVI阳性组及阴性组的3年DFS分别为52.8%和81.5%,二者差异具有统计学意义(P<0.05);EMVI阴性联合血清CA 19-9正常的病人3年复发转移发生率为10.5%,显著低于EMVI阳性联合血清CA19-9升高的病人(54.5%,P<0.05)。结论 CT诊断EMVI阳性和术前血清CA19-9升高是Ⅲ期结肠癌术后3年DFS的独立预后危险因素,可此对Ⅲ期结肠癌可进行更准确的风险分层。
Objective To explore the value of enhanced multi-slice spiral CT (ce MDCT) in the diagnosis of 3-year disease-free survival (DFS) in patients with colon cancer with vascular wall invasion (EMVI). Methods The clinical and pathological data and preoperative imaging data of 90 patients with primary colon cancer who underwent radical surgical resection and confirmed by pathology from February 2009 to December 2013 in Peking University People’s Hospital were collected. According to preoperative ce MDCT imaging features to determine the positive colon cancer EMVI colon block directly into the colon wall outside the vascular cavity. Kaplan-Meier method was used to compare the 3-year DFS difference in patients with colon cancer; Cox proportional hazards model was used to analyze the 3-year DFS and independent predictors of colon cancer patients by single factor and multivariate analysis; chi-square test was used to compare the incidence of recurrence and metastasis in patients with colon cancer. Results According to the American Joint Commission on Cancer (AJCC) criteria, 90 patients with colon cancer diagnosed as stage III were included in this retrospective study. Cox multivariate analysis showed that the positive results of ce MDCT in diagnosis of EMVI (HR = 3.266,95% CI 1.648-7.173, P = 0.003) and preoperative serum CA19-9≥37 kU / L (HR = 2.229,95% CI 1.040 ~ 4.776, P = 0.039) is an independent risk factor for predicting 3-year DFS in patients with stage III colon cancer. The 3-year DFS of EMVI positive group and negative group were 52.8% and 81.5%, respectively, with significant difference (P <0.05); the incidence of 3-year recurrence and metastasis of EMVI negative patients with normal serum CA 19-9 was 10.5 %, Which was significantly lower than that in patients with elevated EMCA positive serum CA19-9 (54.5%, P <0.05). Conclusions The positive diagnosis of CT with EMVI and preoperative serum CA19-9 is an independent prognostic factor for DFS of stage Ⅲ 3-year postoperative colon cancer. This may provide a more accurate risk stratification for stage Ⅲ colon cancer.