增强计算机断层扫描血管造影（CTA）分级可预测胰胆管肿瘤的不可切除性和切缘状态。
Escalating computed tomography angiogram (CTA) grade predicts unresectability and margin status for pancreaticobiliary neoplasms.
机构信息
Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
出版信息
HPB (Oxford). 2010 Mar;12(2):115-22. doi: 10.1111/j.1477-2574.2009.00145.x.
BACKGROUND AND AIMS
The Raptopoulos computed tomography (CT) grading system of pancreaticobiliary cancers was conceived to predict resectability based on tumour involvement of critical vasculature. The aim of the present study was to investigate the relationship between CT grade, resectability, margin status and survival after pancreatic resection.
METHODS
Patients with presumed pancreaticobiliary malignancy and a pancreas protocol computed tomography angiogram (CTA) who underwent attempted curative resection from October 2001 and August 2008 were identified. The relationship between radiographical involvement of critical vasculature, according to a five-point scale, and ultimate resectability, margin status and survival was assessed.
RESULTS
Overall, 276 (70.2%) out of 393 patients were resectable. The proportion of patients who were unresectable at laparotomy increased as CT grade escalated; 41/250 (16.4%) CT Grade 0, 16/55 (29.1%) CT Grade 1, 33/55 (60%) CT Grade 2, 27/33 CT Grade 3, P < 0.001. Local invasion or vascular involvement was the reason for unresectability in 14/41, 12/16, 23/33, 16/27 patients with CT Grade 0-3, respectively. A R0 resection was achieved in 84/131 patients with pancreatic adenocarcinoma and varied significantly by CT grade, P= 0.021. Significant predictors of survival were age (P < 0.0001), resectability (P < 0.0001) and diagnosis (P < 0.009).
CONCLUSIONS
Escalating Raptopoulos CT grade is correlated with increasing probability of unresectability and R1 resection.
背景与目的
Raptopoulos 计算机断层扫描（CT）分级系统是为预测胰腺胆道恶性肿瘤的可切除性而设计的，其依据是肿瘤对关键脉管的侵犯程度。本研究旨在探讨 CT 分级、可切除性、切缘状态与胰腺切除术后生存之间的关系。
方法
回顾性分析 2001 年 10 月至 2008 年 8 月期间，因疑似胰腺胆道恶性肿瘤而行胰腺方案 CT 血管造影术（CTA）检查并尝试行根治性切除术的患者资料。评估了根据五分制的关键脉管受累程度与最终可切除性、切缘状态和生存之间的关系。
结果
共有 393 例患者中，276 例（70.2%）为可切除性。剖腹探查时无法切除的患者比例随 CT 分级的升高而增加；CT 分级 0 级患者中不可切除者为 41 例（16.4%），CT 分级 1 级患者中不可切除者为 16 例（29.1%），CT 分级 2 级患者中不可切除者为 33 例（60%），CT 分级 3 级患者中不可切除者为 27 例（69.2%），差异有统计学意义（P<0.001）。CT 分级 0-3 级患者中，局部侵犯或血管受累导致不可切除的分别为 14 例、12 例、23 例和 16 例。在 131 例胰腺腺癌患者中，有 84 例实现了 R0 切除，CT 分级差异有统计学意义（P=0.021）。生存的显著预测因素为年龄（P<0.0001）、可切除性（P<0.0001）和诊断（P<0.009）。
结论
Raptopoulos CT 分级的升高与不可切除性和 R1 切除率的增加相关。
Zotero 插件