弥散加权成像预测食管癌放疗近期疗效的临床研究
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摘要
背景食管癌死亡率位居恶性肿瘤第四位,五年生存率仅为5%-20%,预后较差.精确放疗虽是食管癌患者获得长期局部控制及生存获益的重要手段,但实体瘤疗效评价标准基于肿瘤体积缩小评价疗效具一定滞后性,并不适用于食管癌.目的研究弥散加权成像(diffusion-weighted imaging, DWI)预测食管癌放疗近期疗效的临床价值.方法将2011-01/2014-07间拟在赣南医学院第一附属医院接受放疗的49例食管鳞癌患者纳入研究范围,患者均分别于放疗前一周时、放疗中、放疗后行MRI-DWI,参照实体瘤疗效标准评价化疗疗效,以是否客观有效暴露分组,对比两组放疗前一周时、放疗中、放疗后表观扩散系数(apparent diffusion coefficient, ADC)及放疗前中ADC变化率(△ADC),并采用ROC曲线分析ADC预测食管癌近期放疗疗效的最佳阀值.结果 49例食管癌患者放疗中、放疗后食管病变长度均显著缩短(P<0.05),客观有效38(77.55%)例,客观无效11(22.45%)例;同时,放疗中ADC平均值显著高于放疗前一周时(P <0.05);且客观有效组放疗中ADC值、放疗后ADC值、△ADC均显著高于客观无效组(P <0.05),经ROC曲线下分析, ADC变化值、△ADCROC曲线下面积分别为0.950、0.941,以0.280×10~(-3)mm~2/s为AUC变化值阈值时,其预测食管癌放疗疗效的敏感度为88.47%、特异度为100.00%、准确度为86.17%、阳性预测值为95.77%、阴性预测值仅为39.92%;以22.38%为ADC阈值时,△ADC预测放疗的敏感度为84.57%、特异度为100.00%、准确度为86.17%、阳性预测值为100.00%、阴性预测值为43.04%.结论 DWI用于食管癌放疗近期疗效预测有一定临床价值,ADC变化值、△ADC的高特异度、高阳性预测值均值得重视.
BACKGROUND The mortality of esophageal cancer ranks fourth among all malignant tumors, and the 5-year survival rate is only 5%-20%. Although precise radiotherapy is animportant means of obtaining long term local control and survival in patients with esophageal cancer, the curative effect evaluation standard for solid tumors(response evaluation criteria in solid tumors) based on tumor size does not apply to esophageal cancer.AIM To assess the clinical value of diffusion-weighted imaging(DWI) in predicting the short-term efficacy of radiotherapy for esophageal cancer.METHODS A total of 49 patients with esophageal squamous cell carcinoma who were scheduled to be treated with radiotherapy at the First Affiliated Hospital of Gannan Medical College from January 2011 to July 2014 were enrolled in the study. All of the patients underwent MRIDWI 1 wk before radiotherapy, during radiotherapy, and after radiotherapy. The curative effect of radiotherapy was evaluated by referring to the evaluation standard of the curative effect on solid tumor. The patients were grouped according to the effect of radiotherapy. The apparent diffusion coefficient(ADC) values at 1 wk before radiotherapy, during radiotherapy, and after radiotherapy, and the change rate of ADC(△ADC) before and during radiotherapy were compared between the two groups. The optimal threshold of ADC in predicting the short-term curative effect of radiotherapy for esophageal cancer was analyzed by ROC curve analysis.RESULTS The length of the affected esophagus was significantly shortened during and after radiotherapy(P < 0.05). There were 38(77.55%) cases of objective effectiveness(77.55%) and 11(22.45%) cases of objective ineffectiveness. The mean value of ADC during radiotherapy was significantly higher than that at 1 week before radiotherapy(P < 0.05). The ADC values during radiotherapy and after radiotherapy and △ADC in the objectively effective group were significantly higher than those in the objectively ineffective group(P < 0.05). ROC curve analysis showed that the areas under the ROC curves of ADC change value and △ADC were 0.950 and 0.941, respectively. When the threshold value of ADC change value was 0.280 × 10~(-3) mm~2/s, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 88.47%, 100.00%, 86.17%, 95.77%, and 39.92%, respectively. When the threshold of ADC was 2.238%, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of △ADC for predicting the curative effect of radiotherapy were 84.57%, 100.00%, 86.17%, 100.00%, and 43.04%, respectively.CONCLUSION DWI is of certain clinical value in predicting the shortterm curative effect of radiotherapy for esophageal cancer with regard to the change value of ADC and △ADC.
BACKGROUND The mortality of esophageal cancer ranks fourth among all malignant tumors, and the 5-year survival rate is only 5%-20%. Although precise radiotherapy is animportant means of obtaining long term local control and survival in patients with esophageal cancer, the curative effect evaluation standard for solid tumors(response evaluation criteria in solid tumors) based on tumor size does not apply to esophageal cancer.AIM To assess the clinical value of diffusion-weighted imaging(DWI) in predicting the short-term efficacy of radiotherapy for esophageal cancer.METHODS A total of 49 patients with esophageal squamous cell carcinoma who were scheduled to be treated with radiotherapy at the First Affiliated Hospital of Gannan Medical College from January 2011 to July 2014 were enrolled in the study. All of the patients underwent MRIDWI 1 wk before radiotherapy, during radiotherapy, and after radiotherapy. The curative effect of radiotherapy was evaluated by referring to the evaluation standard of the curative effect on solid tumor. The patients were grouped according to the effect of radiotherapy. The apparent diffusion coefficient(ADC) values at 1 wk before radiotherapy, during radiotherapy, and after radiotherapy, and the change rate of ADC(△ADC) before and during radiotherapy were compared between the two groups. The optimal threshold of ADC in predicting the short-term curative effect of radiotherapy for esophageal cancer was analyzed by ROC curve analysis.RESULTS The length of the affected esophagus was significantly shortened during and after radiotherapy(P < 0.05). There were 38(77.55%) cases of objective effectiveness(77.55%) and 11(22.45%) cases of objective ineffectiveness. The mean value of ADC during radiotherapy was significantly higher than that at 1 week before radiotherapy(P < 0.05). The ADC values during radiotherapy and after radiotherapy and △ADC in the objectively effective group were significantly higher than those in the objectively ineffective group(P < 0.05). ROC curve analysis showed that the areas under the ROC curves of ADC change value and △ADC were 0.950 and 0.941, respectively. When the threshold value of ADC change value was 0.280 × 10~(-3) mm~2/s, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 88.47%, 100.00%, 86.17%, 95.77%, and 39.92%, respectively. When the threshold of ADC was 2.238%, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of △ADC for predicting the curative effect of radiotherapy were 84.57%, 100.00%, 86.17%, 100.00%, and 43.04%, respectively.CONCLUSION DWI is of certain clinical value in predicting the shortterm curative effect of radiotherapy for esophageal cancer with regard to the change value of ADC and △ADC.
引文
1 Arnold M,Laversanne M,Brown LM,Devesa SS,Bray F.Predicting the Future Burden of Esophageal Cancer by Histological Subtype:International Trends in Incidence up to2030.Am J Gastroenterol 2017;112:1247-1255[PMID:28585555DOI:10.1038/ajg.2017.155]
2 Liu M,Zhao K,Chen Y,Jiang GL.Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer:a retrospective analysis.Radiat Oncol 2014;9:232[PMID:25344056 DOI:10.1186/s13014-014-0232-4]
3 King AD,Thoeny HC.Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma:potential and limitations.Cancer Imaging 2016;16:23[PMID:27542718 DOI:10.1186/s40644-016-0080-6]
4谢铁明,邵国良,庞佩佩.D W I和D C E-M R I定量评价食管癌放化疗疗效的应用.放射学实践2017;32:755-757[DOI:10.13609/j.cnki.1000-0313.2017.07.020]
5刘辉,时高峰,邵娴,许茜,贾立涛,翟英敏.磁共振弥散加权成像在食管癌放疗疗效中的应用以及评价价值.中国现代医学杂志2014;24:57-61[DOI:10.3969/j.issn.1002-7386.2013.22.018]
6中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案).中华放射肿瘤学杂志2010;19:179-180[DOI:10.3760/cma.j.issn.1004-4221.2010.03.001]
7杨学宁,吴一龙.实体瘤治疗疗效评价标准-RECIST.循证医学2004;4:85-90[DOI:10.3969/j.issn.1671-5144.2004.02.012]
8李广虎,钱立庭.磁共振弥散加权成像(D W I)在食管癌放疗中的应用进展.中华放射肿瘤学杂志2017;26:239-242[DOI:10.3760/cma.j.issn.1004-4221.2017.02.023]
9 Yang L,Son J B,Ma J,Cheng J.MO-F-CAMPUS-I-05:Quantitative ADC Measurement of Esophageal Cancer Before and After Chemoradiation.Medical Physics 2015;42:3579-3579[DOI:10.1118/1.4925471]
10蒋鸣,陶华,沈波,徐池.MR扩散加权成像对食管癌患者同步放化疗疗效的预测价值.现代肿瘤医学2016;24:3563-3567[DOI:10.3969/j.issn.1672-4992.2016.22.012]
11 Wu X,Reinikainen P,Kapanen M,Vierikko T,Ryymin P,Kellokumpu-Lehtinen PL.Diffusion-weighted magnetic resonance imaging provides a useful biomarker for evaluation radiotherapy efficacy in patients with prostate cancer.Anticancer Res 2017;16:e2716[PMID:28870929 DOI:10.21873/anticanres.11917]
12 Liu YH,Xu L,Liu LH,Liu XS,Hou ZY,Hou DL,Chen ZQ,Li WW,Huang Y.3.0T MR-CAD:Clinical Value in Diagnosis of Breast Tumor Compared with Conventional MRI.J Cancer2014;5:585-589[PMID:25057309 DOI:10.7150/jca.9785]
13张前芳,杨星,詹利平.IVIM双指数模型多b值DWI在脑肿瘤诊断及分级中的应用.现代肿瘤医学2018;26:603-608[DOI:10.3969/j.issn.1672-4992.2018.04.031]
14张立,刘璋,吴恩柱,邱子维,王博,肖海松,高文,王潇.磁共振全身弥散加权成像结合磁共振常规扫描在恶性肿瘤个体化介入治疗中的应用.中国数字医学2018;13:98-100[DOI:10.3969/j.issn.1673-7571.2018.02.032]
15张明,吴献华.磁共振弥散加权成像对食管癌患者同期放化疗前后表观弥散系数以及病变长度的影响.中国临床研究2016;29:389-391[DOI:10.13429/j.cnki.cjcr.2016.03.033]
16王鑫,屈东,肖泽芬.MRI在食管癌诊断及放疗中的应用进展.中华放射肿瘤学杂志2017;26:1338-1341[DOI:10.3760/cma.j.issn.1004-4221.2017.11.021]
17王澜,刘丽虹,韩春,田华,任雪姣,时高峰,王琦,高超,王光大.用DWMRI预测食管癌原发灶放化疗疗效的临床研究.中华放射肿瘤学杂志2016;25:1074-1078[DOI:10.3760/cma.j.issn.1004-4221.2016.10.011]
18张安度,韩晶,时高峰,韩春,王澜,王燕飞,张钧,田华,孔洁.MRI在预测食管癌放化疗治疗反应及疗效评估中的应用研究.中华放射医学与防护杂志2016;36:822-826[DOI:10.3760/cma.j.issn.0254-5098.2016.11.005]
2 Liu M,Zhao K,Chen Y,Jiang GL.Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer:a retrospective analysis.Radiat Oncol 2014;9:232[PMID:25344056 DOI:10.1186/s13014-014-0232-4]
3 King AD,Thoeny HC.Functional MRI for the prediction of treatment response in head and neck squamous cell carcinoma:potential and limitations.Cancer Imaging 2016;16:23[PMID:27542718 DOI:10.1186/s40644-016-0080-6]
4谢铁明,邵国良,庞佩佩.D W I和D C E-M R I定量评价食管癌放化疗疗效的应用.放射学实践2017;32:755-757[DOI:10.13609/j.cnki.1000-0313.2017.07.020]
5刘辉,时高峰,邵娴,许茜,贾立涛,翟英敏.磁共振弥散加权成像在食管癌放疗疗效中的应用以及评价价值.中国现代医学杂志2014;24:57-61[DOI:10.3969/j.issn.1002-7386.2013.22.018]
6中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准(草案).中华放射肿瘤学杂志2010;19:179-180[DOI:10.3760/cma.j.issn.1004-4221.2010.03.001]
7杨学宁,吴一龙.实体瘤治疗疗效评价标准-RECIST.循证医学2004;4:85-90[DOI:10.3969/j.issn.1671-5144.2004.02.012]
8李广虎,钱立庭.磁共振弥散加权成像(D W I)在食管癌放疗中的应用进展.中华放射肿瘤学杂志2017;26:239-242[DOI:10.3760/cma.j.issn.1004-4221.2017.02.023]
9 Yang L,Son J B,Ma J,Cheng J.MO-F-CAMPUS-I-05:Quantitative ADC Measurement of Esophageal Cancer Before and After Chemoradiation.Medical Physics 2015;42:3579-3579[DOI:10.1118/1.4925471]
10蒋鸣,陶华,沈波,徐池.MR扩散加权成像对食管癌患者同步放化疗疗效的预测价值.现代肿瘤医学2016;24:3563-3567[DOI:10.3969/j.issn.1672-4992.2016.22.012]
11 Wu X,Reinikainen P,Kapanen M,Vierikko T,Ryymin P,Kellokumpu-Lehtinen PL.Diffusion-weighted magnetic resonance imaging provides a useful biomarker for evaluation radiotherapy efficacy in patients with prostate cancer.Anticancer Res 2017;16:e2716[PMID:28870929 DOI:10.21873/anticanres.11917]
12 Liu YH,Xu L,Liu LH,Liu XS,Hou ZY,Hou DL,Chen ZQ,Li WW,Huang Y.3.0T MR-CAD:Clinical Value in Diagnosis of Breast Tumor Compared with Conventional MRI.J Cancer2014;5:585-589[PMID:25057309 DOI:10.7150/jca.9785]
13张前芳,杨星,詹利平.IVIM双指数模型多b值DWI在脑肿瘤诊断及分级中的应用.现代肿瘤医学2018;26:603-608[DOI:10.3969/j.issn.1672-4992.2018.04.031]
14张立,刘璋,吴恩柱,邱子维,王博,肖海松,高文,王潇.磁共振全身弥散加权成像结合磁共振常规扫描在恶性肿瘤个体化介入治疗中的应用.中国数字医学2018;13:98-100[DOI:10.3969/j.issn.1673-7571.2018.02.032]
15张明,吴献华.磁共振弥散加权成像对食管癌患者同期放化疗前后表观弥散系数以及病变长度的影响.中国临床研究2016;29:389-391[DOI:10.13429/j.cnki.cjcr.2016.03.033]
16王鑫,屈东,肖泽芬.MRI在食管癌诊断及放疗中的应用进展.中华放射肿瘤学杂志2017;26:1338-1341[DOI:10.3760/cma.j.issn.1004-4221.2017.11.021]
17王澜,刘丽虹,韩春,田华,任雪姣,时高峰,王琦,高超,王光大.用DWMRI预测食管癌原发灶放化疗疗效的临床研究.中华放射肿瘤学杂志2016;25:1074-1078[DOI:10.3760/cma.j.issn.1004-4221.2016.10.011]
18张安度,韩晶,时高峰,韩春,王澜,王燕飞,张钧,田华,孔洁.MRI在预测食管癌放化疗治疗反应及疗效评估中的应用研究.中华放射医学与防护杂志2016;36:822-826[DOI:10.3760/cma.j.issn.0254-5098.2016.11.005]