多排螺旋 CT 检查可切除的食管胃结合部腺癌的肿瘤体积与区域淋巴结转移及 N 分期的关系。
Tumor volume of resectable adenocarcinoma of the esophagogastric junction at multidetector CT: association with regional lymph node metastasis and N stage.
机构信息
Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63 Wenhua Rd, Shunqing District, Nanchong 637000 Sichuan, China.
出版信息
Radiology. 2013 Oct;269(1):130-8. doi: 10.1148/radiol.13122269. Epub 2013 May 8.
PURPOSE
To determine whether the volume of resectable adenocarcinoma of the esophagogastric junction (AEG) measured at multidetector computed tomography (CT) is associated with regional lymph node metastasis and N stage.
MATERIALS AND METHODS
The study was approved by the institutional ethics committee, and written informed consent was obtained from each participant. Two hundred sixteen patients with resectable AEG prospectively underwent contrast material-enhanced thoracoabdominal multidetector CT less than 2 weeks before curative resection. Gross tumor volume was retrospectively measured on CT scans. Univariate and multivariate analyses were performed to identify whether gross tumor volume is associated with regional lymph node metastasis. The Mann-Whitney U test was performed to compare gross tumor volume among N stages, with Bonferroni correction for multigroup comparisons. Receiver operating characteristic analysis was performed to determine if gross tumor volume could help classify N stage.
RESULTS
Univariate analysis showed that gross tumor volume is associated with regional lymph node metastasis (P < .0001). Multivariate analysis revealed that gross tumor volume is an independent risk factor of lymph node metastasis (P = .023, odds ratio = 2.791). The Mann-Whitney U test showed that gross tumor volume could help differentiate between stage N0 and stages N1-N2 or N1-N3 disease and between stages N1-N2 and stage N3 disease (P < .0001 for all). In patients with stage T1-T3 AEG, gross tumor volume could help differentiate between stage N0 and stages N1-N2 (cutoff, 15.23 cm(3)) or N1-N3 (cutoff, 17.16 cm(3)) disease and between stages N1-N2 and stage N3 disease (cutoff, 33.96 cm(3)). In patients with stage T3 AEG, gross tumor volume could help differentiate stage N0 from stages N1-N2 (cutoff, 18.41 cm(3)) or N1-N3 (cutoff, 19.30 cm(3)) disease and stages N1-N2 from stage N3 disease (cutoff, 33.96 cm(3)).
CONCLUSION
Gross tumor volume of AEG measured with multidetector CT is associated with regional lymph node metastasis and N stage.
目的
确定多排螺旋 CT 测量的食管胃结合部可切除腺癌（AEG）体积是否与局部淋巴结转移和 N 分期有关。
材料与方法
本研究经机构伦理委员会批准，每位参与者均签署书面知情同意书。216 例可切除 AEG 患者前瞻性地在根治性切除前 2 周内行对比增强胸腹多排螺旋 CT 检查。回顾性测量 CT 扫描上的大体肿瘤体积。采用单因素和多因素分析来确定大体肿瘤体积是否与局部淋巴结转移有关。采用 Mann-Whitney U 检验比较 N 分期之间的大体肿瘤体积，并用 Bonferroni 校正进行多组比较。进行受试者工作特征分析，以确定大体肿瘤体积是否有助于 N 分期分类。
结果
单因素分析显示，大体肿瘤体积与局部淋巴结转移有关（P<0.0001）。多因素分析显示，大体肿瘤体积是淋巴结转移的独立危险因素（P=0.023，优势比=2.791）。Mann-Whitney U 检验显示，大体肿瘤体积有助于区分 N0 期与 N1-N2 期或 N1-N3 期，以及 N1-N2 期与 N3 期（所有 P<0.0001）。在 T1-T3 期 AEG 患者中，大体肿瘤体积有助于区分 N0 期与 N1-N2 期（截断值为 15.23cm3）或 N1-N3 期（截断值为 17.16cm3），以及 N1-N2 期与 N3 期（截断值为 33.96cm3）。在 T3 期 AEG 患者中，大体肿瘤体积有助于区分 N0 期与 N1-N2 期（截断值为 18.41cm3）或 N1-N3 期（截断值为 19.30cm3），以及 N1-N2 期与 N3 期（截断值为 33.96cm3）。
结论
多排螺旋 CT 测量的 AEG 大体肿瘤体积与局部淋巴结转移和 N 分期有关。
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