Zhu Liang, Shi Xiaohua, Xue Huadan, Wu Huanwen, Chen Ge, Sun Hao, He Yonglan, Jin Zhengyu, Liang Zhiyong, Zhang Zhuoli
From the Department of Radiology (LZ, HX, HS, YH, ZJ); Department of Pathology (XS, HW, ZL); Department of Surgery, Peking Union Medical College Hospital (GC), Beijing, China; Department of Radiology, Northwestern University, Chicago, IL (ZZ); and Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China (ZZ).
Medicine (Baltimore). 2016 Feb;95(5):e2664. doi: 10.1097/MD.0000000000002664.
This study aimed to determine whether changes in contrast-enhanced computed tomography (CT) parameters could predict postsurgery overall and progression-free survival (PFS) in pancreatic cancer patients. Seventy-nine patients with a final pathological diagnosis of pancreatic adenocarcinoma were included in this study from June 2008 to August 2012. Dynamic contrast-enhanced (DCE) CT of tumors was obtained before curative-intent surgery. Absolute enhancement change (AEC) and relative enhancement change (REC) were evaluated on DCE-CT. PFS and overall survival (OS) were compared based on CT enhancement patterns. The markers of fibrogenic alpha-smooth muscle antigen (α-SMA) and periostin in tumor specimens were evaluated by immunohistochemical staining. The χ test was performed to determine whether CT enhancement patterns were associated with α-SMA-periostin expression levels (recorded as positive or negative). Lower REC (<0.9) was associated with shorter PFS (HR 0.51, 95% CI: 0.31-0.89) and OS (HR 0.44, 95% CI: 0.25-0.78). The α-SMA and periostin expression level were negatively correlated with REC (both P = 0). Among several CT enhancement parameters, REC was the best predictor of patient postsurgery survival. Low REC was associated with a short progression-free time and poor survival. The pathological studies suggested that REC might be a reflection of cancer fibrogenic potential.
本研究旨在确定对比增强计算机断层扫描（CT）参数的变化是否能够预测胰腺癌患者术后的总生存期和无进展生存期（PFS）。2008年6月至2012年8月，本研究纳入了79例最终病理诊断为胰腺腺癌的患者。在进行根治性手术前，对肿瘤进行动态对比增强（DCE）CT检查。在DCE-CT上评估绝对增强变化（AEC）和相对增强变化（REC）。根据CT增强模式比较PFS和总生存期（OS）。通过免疫组织化学染色评估肿瘤标本中促纤维化α平滑肌抗原（α-SMA）和骨膜蛋白的标志物。进行χ检验以确定CT增强模式是否与α-SMA-骨膜蛋白表达水平（记录为阳性或阴性）相关。较低的REC（<0.9）与较短的PFS（风险比[HR]0.51，95%置信区间[CI]：0.31-0.89）和OS（HR 0.44，95%CI：0.25-0.78）相关。α-SMA和骨膜蛋白表达水平与REC呈负相关（均P = 0）。在几个CT增强参数中，REC是患者术后生存的最佳预测指标。低REC与较短的无进展时间和较差的生存率相关。病理研究表明，REC可能反映了癌症的促纤维化潜能。
