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高分辨率磁共振成像联合CALLY指数对局部晚期直肠癌患者壁外血管侵犯的预测价值

Predictive value of high-resolution magnetic resonance imaging combined with CALLY index for extramural vascular invasion in patients with locally advanced rectal cancer

    摘要
  • 摘要:
    目的 探讨新辅助放化疗(NCRT)前高分辨率磁共振成像(HR-MRI)联合CALLY指数对局部晚期直肠癌(LARC)患者壁外血管侵犯(EMVI)的预测价值。
    方法 回顾性选取129例LARC患者作为研究对象, 收集其NCRT前HR-MRI影像学特征及相关血清学指标，计算CALLY指数由C反应蛋白(CRP)、淋巴细胞(LYM)计数、白蛋白(ALB)构成的复合指数。根据术后病理结果，将患者分为EMVI阳性组(48例)和EMVI阴性组(81例)。采用Logistic回归分析筛选EMVI发生的影响因素; 绘制受试者工作特征(ROC)曲线，分析CALLY指数和HR-MRI评估结果对EMVI的预测效能。
    结果 EMVI阳性组T分期为T3~4期者占比、HR-MRI评估EMVI阳性者占比均高于EMVI阴性组, CRP、中性粒细胞(NEU)、癌胚抗原(CEA)、红细胞分布宽度(RDW)水平高于EMVI阴性组，LYM、ALB、CALLY指数水平低于EMVI阴性组，差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示，年龄、T分期、HR-MRI评估EMVI结果、CEA、CALLY指数均为LARC患者EMVI阳性的独立影响因素(P < 0.05)。ROC曲线分析显示, NCRT前CALLY指数预测EMVI的曲线下面积(AUC)为0.757(95%CI: 0.674~0.828), HR-MRI评估结果的AUC为0.779(95%CI: 0.697~0.847), 两者联合预测的AUC为0.870(95%CI: 0.799~0.923)。
    结论 NCRT前HR-MRI联合CALLY指数对LARC患者EMVI具有较高的预测价值，可为个体化治疗提供重要参考。

     

    Abstract:
    Objective To investigate the predictive value of high-resolution magnetic resonance imaging (HR-MRI) combined with CALLY index for extramural vascular invasion (EMVI) in patients with locally advanced rectal cancer (LARC) before neoadjuvant chemoradiotherapy (NCRT).
    Methods A total of 129 patients with LARC were retrospectively selected as the study subjects. The HR-MRI imaging features and relevant serological indicators before NCRT were collected, and the CALLY index a composite index composed of C-reactive protein (CRP), lymphocyte (LYM) count, and albumin (ALB)was calculated. According to the postoperative pathological results, the patients were divided into EMVI-positive group (48 cases)and EMVI-negative group (81 cases). Logistic regression analysis was used to screen the influencing factors for the occurrence of EMVI. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of the CALLY index and HR-MRI assessment results for EMVI.
    Results The proportion of patients with T stage of T3~4 and the proportion of patients with positive EMVI assessed by HR-MRI in the EMVI-positive group were higher than those in the EMVI-negative group (P < 0.05). The levels of CRP, neutrophils (NEU), carcinoembryonic antigen (CEA), and red blood cell distribution width (RDW) in the EMVI-positive group were higher than those in the EMVI-negative group, while the levels of LYM, ALB, and CALLY index were lower than those in the EMVI-negative group, with statistically significant differences (P < 0.05). Multivariate Logistic regression analysis showedthat age, T stage, HR-MRI assessment result of EMVI, CEA and CALLY index were all independent influencing factors for EMVI positivity in patients with LARC (P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of the CALLY index for predicting EMVI before NCRT was 0.757 (95%CI, 0.674 to 0.828), the AUC of the HR-MRI assessment result was 0.779(95%CI, 0.697 to 0.847), and the AUC of the combined prediction of the two was 0.870 (95%CI, 0.799 to 0.923).
    Conclusion HR-MRI combined with CALLY index before NCRT has a high predictive value for EMVI in patients with LARC and can provide an important reference for individualized treatment.

     

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