平衡对比增强 CT 计算细胞外容积分数对胰腺神经内分泌肿瘤的预后意义。
Prognostic significance of extracellular volume fraction with equilibrium contrast-enhanced computed tomography for pancreatic neuroendocrine neoplasms.
机构信息
Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan; Department of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Tochigi, 329-0498, Japan.
Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City, 890-8544, Japan.
出版信息
Pancreatology. 2021 Jun;21(4):779-786. doi: 10.1016/j.pan.2021.02.020. Epub 2021 Mar 3.
BACKGROUND
/Objectives: Identifying reliable pretreatment imaging biomarkers for pancreatic neuroendocrine neoplasm (PanNEN) is a key imperative. Extracellular volume (ECV) fraction quantified with equilibrium contrast-enhanced CT can be easily integrated into routine examinations. This study aimed to determine whether ECV fraction with equilibrium contrast-enhanced computed tomography (CECT) could predict long-term outcomes in patients with PanNEN.
METHODS
This study was a retrospective observational study of 80 patients pathologically diagnosed with PanNEN at a single institution. ECV fraction of the primary lesion was calculated using region-of-interest measurement within PanNEN and the aorta on unenhanced and equilibrium CECT. The impact of clinical factors and tumor ECV fraction on progression-free survival (PFS) and overall survival (OS) was assessed with univariate and multivariate analyses using Cox proportional hazards models. The correlation between WHO classification and tumor ECV fraction was evaluated using Kendall rank correlation coefficients.
RESULTS
PFS and OS rates were estimated as 93.4% and 94.6%, 78.7% and 86.2%, 78.7% and 77.0%, and 78.7% and 66.6% at 1, 3, 5, and 10 years, respectively. Multivariate analysis revealed that Union for International Cancer Control (UICC) stage (hazard ratio [HR] = 3.95, P = 0.003), WHO classification (HR = 12.27, P = 0.003), and tumor ECV fraction (HR = 11.93, P = 0.039) were independent predictors of PFS. Patient age (HR = 1.11, P < 0.001), UICC stage (HR = 3.14, P = 0.001), and tumor ECV fraction (HR = 5.27, P = 0.024) were independent significant variables for predicting OS. Tumor ECV fraction had a weak inverse relationship with WHO classification (P = 0.045, τ = -0.178).
CONCLUSIONS
ECV fraction determined by equilibrium CECT and UICC stage may predict survival in patients with PanNEN.
背景/目的：确定可靠的胰腺神经内分泌肿瘤（PanNEN）的术前成像生物标志物是当务之急。通过平衡对比增强 CT 量化的细胞外容积（ECV）分数可以很容易地纳入常规检查。本研究旨在确定平衡对比增强 CT（CECT）的 ECV 分数是否可以预测 PanNEN 患者的长期预后。
方法
这是一项在单一机构对经病理诊断为 PanNEN 的 80 例患者进行的回顾性观察研究。通过 PanNEN 和主动脉在未增强和平衡 CECT 上的 ROI 测量，计算出原发肿瘤的 ECV 分数。使用 Cox 比例风险模型进行单因素和多因素分析，评估临床因素和肿瘤 ECV 分数对无进展生存期（PFS）和总生存期（OS）的影响。使用 Kendall 秩相关系数评估 WHO 分级与肿瘤 ECV 分数之间的相关性。
结果
估计的 PFS 和 OS 率分别为 1 年时的 93.4%和 94.6%、3 年时的 78.7%和 86.2%、5 年时的 78.7%和 77.0%、以及 10 年时的 78.7%和 66.6%。多因素分析显示，国际抗癌联盟（UICC）分期（风险比[HR] = 3.95，P = 0.003）、WHO 分级（HR = 12.27，P = 0.003）和肿瘤 ECV 分数（HR = 11.93，P = 0.039）是 PFS 的独立预测因素。患者年龄（HR = 1.11，P < 0.001）、UICC 分期（HR = 3.14，P = 0.001）和肿瘤 ECV 分数（HR = 5.27，P = 0.024）是预测 OS 的独立显著变量。肿瘤 ECV 分数与 WHO 分级呈弱负相关（P = 0.045，τ = -0.178）。
结论
平衡 CECT 测定的 ECV 分数和 UICC 分期可能预测 PanNEN 患者的生存情况。
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