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

doi:10.19401/j.cnki.1007-3639.2018.05.009

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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

论著 | 更新时间：2026-01-27

- 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
- Value of preoperative magnetic resonance imaging in predicting postoperative recurrence and metastasis of middle rectal cancer
- 中国癌症杂志 2018年28卷第5期页码：376-382
- 作者机构：
  
  哈尔滨医科大学附属肿瘤医院影像科,黑龙江,哈尔滨,150000
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2018.05.009
  中图分类号： R445.2;R735.37
- 网络出版：2018-06-12，
  
  纸质出版：2018-06-12
- 稿件说明：
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徐　晔,周　洋,唐　娜,等. 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[J]. 中国癌症杂志, 2018, 28(5): 376-382.

徐　晔, 周　洋, 唐　娜. Value of preoperative magnetic resonance imaging in predicting postoperative recurrence and metastasis of middle rectal cancer[J]. China Oncology, 2018, 28(5): 376-382.
徐　晔,周　洋,唐　娜,等. 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[J]. 中国癌症杂志, 2018, 28(5): 376-382. DOI： 10.19401/j.cnki.1007-3639.2018.05.009.

徐　晔, 周　洋, 唐　娜. Value of preoperative magnetic resonance imaging in predicting postoperative recurrence and metastasis of middle rectal cancer[J]. China Oncology, 2018, 28(5): 376-382. DOI： 10.19401/j.cnki.1007-3639.2018.05.009.

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。

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 (P0.001). And mrT staging (P=0.013)

mrN staging (P0.001)

extramural vascular invasion (EMVI) (P0.001) and peritoneal reflection invasion (P0.001) 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 (P0.001). Both the mrN1 staging (P=0.017) and mrN2 staging (P0.001) 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.

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