中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (5): 376-382.doi: 10.19401/j.cnki.1007-3639.2018.05.009

• 论著 • 上一篇    下一篇

中段直肠癌术前磁共振成像对术后复发及转移的预测价值研究

徐 晔,周 洋,唐 娜,张修石   

  1. 哈尔滨医科大学附属肿瘤医院影像科,黑龙江 哈尔滨 150000
  • 出版日期:2018-05-30 发布日期:2018-06-12
  • 通信作者: 张修石 E-mail: xiushiz@163.com

Value of preoperative magnetic resonance imaging in predicting postoperative recurrence and metastasis of middle rectal cancer

XU Ye, ZHOU Yang, TANG Na, ZHANG Xiushi   

  1. Department of Imaging Diagnosis, Harbin Medical University Cancer Hospital, Harbin 150000, Heilongjiang Province, China
  • Published:2018-05-30 Online:2018-06-12
  • Contact: ZHANG Xiushi E-mail: xiushiz@163.com

摘要: 背景与目的:中段直肠癌根治性切除术后局部复发率和异时远处转移率较高,如果能够在术前筛选出术后局部复发及远处转移的高危人群,就有可能对高危人群进行针对性的系统治疗,改善患者预后。该研究旨在探讨中段直肠癌术前磁共振成像(magnetic resonance imaging,MRI)对术后局部复发及异时远处转移的预测价值。方法:回顾性分析哈尔滨医科大学附属肿瘤医院2013年3月—2014年12月经手术病理证实为直肠癌,并且术前MRI判断为中段直肠癌的患者278例,收集其MRI资料及随访资料,分析直肠癌术前MRI与术后局部复发及异时远处转移的相关性、直肠癌术后局部复发和异时远处转移的风险因素以及通过术前MRI预测直肠癌预后的价值。结果:278例患者中19例(6.83%)发生术后局部复发,42例(15.11%)发生异时远处转移。单因素分析结果表明,MRI评价T(mrT)分期(P<0.001)、腹膜返折受侵(P<0.001)与直肠癌术后局部复发具有相关性;mrT分期(P=0.013)、MRI评价N(mrN)分期(P<0.001)、壁外血管侵犯(extramural vascular invasion,EMVI)(P<0.001)、腹膜返折受侵(P<0.001)与直肠癌异时远处转移具有相关性。逐步回归模型结果显示,腹膜返折受侵(P<0.001)是直肠癌术后局部复发的重要风险因素;mrN1期(P=0.017)、mrN2期(P<0.001)是直肠癌异时远处转移的重要风险因素。结论:直肠癌术前MRI能较好地预测术后局部复发和异时远处转移,有助于临床筛选高危患者,从而采取个性化治疗,以改善患者预后。

关键词: 中段直肠癌, 磁共振成像, 局部复发, 远处转移

Abstract: Background and purpose: Middle rectal cancer has higher local recurrence rate and metachronous distant metastasis rate after radical resection. If the high-risk populations of local recurrence and metachronous distant metastasis can be selected before the operation, the targeted treatment can be carried out for the high-risk groups, so as to improve the prognosis of patients. Our retrospective study was aimed to analyze the value of preoperative magnetic resonance imagine (MRI) in predicting postoperative recurrence and metachronous distant metastasis of middle rectal cancer. Methods: We retrospectively analyzed preoperative MRI and follow-up data of 278 patients with middle rectal cancer confirmed by histopathology at our hospital from March 2013 to December 2014. The correlations of MRI features with postoperative recurrence and metachronous distant metastasis were evaluated. The risk factors for postoperative recurrence and metachronous distant metastasis were analyzed. Results: Among 278 patients, 19 patients (6.83%) were confirmed to have postoperative recurrence and 42 patients (15.11%) were confirmed to have metachronous distant metastasis. There were 4 patients who had postoperative recurrence and metachronous distant metastasis at the same time. The mrT staging and peritoneal reflection invasion were significantly correlated with postoperative recurrence (P<0.001). And mrT staging (P=0.013), mrN staging (P<0.001), extramural vascular invasion (EMVI) (P<0.001) and peritoneal reflection invasion (P<0.001) were significantly correlated with metachronous distant metastasis in univariate analysis. Stepwise regression analysis showed peritoneal reflection invasion was a significant risk factor for postoperative recurrence (P<0.001). Both the mrN1 staging (P=0.017) and mrN2 staging (P<0.001) were significant risk factors for metachronous distant metastasis. Conclusion: Preoperative MRI of rectal cancer can provide better prediction of postoperative recurrence and metachronous distant metastasis. Thus, it is helpful in clinical screening of high-risk patients and individualized treatment to improve prognosis.

Key words: Middle rectal cancer, Magnetic resonance imaging, Local recurrence, Distant recurrence