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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (04) : 306 -309. doi: 10.3877/cma.j.issn.2095-2015.2024.04.004

论著

CT肿瘤体积测量参数结合实验室指标对结肠癌术前分期预判的价值
赵文元1,†(), 田玉廷2, 张吉海1, 张军3   
  1. 1. 271600　山东省，肥城市人民医院放疗科
    2. 271600　山东省，肥城市人民医院肿瘤科
    3. 271600　山东省，肥城市人民医院影像科
  • 收稿日期:2024-01-31 出版日期:2024-08-01
  • 通信作者: 赵文元

Value of CT tumor volume measurement parameters combined with laboratory indexes in guiding preoperative staging prediction in patients with colon cancer

Wenyuan Zhao1,†(), Yuting Tian2, Jihai Zhang1, Jun Zhang3   

  1. 1. Department of Radiotherapy, Feicheng People's Hospital, Feicheng 271600, China
    2. Department of Oncology, Feicheng People's Hospital, Feicheng 271600, China
    3. Department of Imaging, Feicheng People's Hospital, Feicheng 271600, China
  • Received:2024-01-31 Published:2024-08-01
  • Corresponding author: Wenyuan Zhao
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赵文元, 田玉廷, 张吉海, 张军. CT肿瘤体积测量参数结合实验室指标对结肠癌术前分期预判的价值[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 306-309.

Wenyuan Zhao, Yuting Tian, Jihai Zhang, Jun Zhang. Value of CT tumor volume measurement parameters combined with laboratory indexes in guiding preoperative staging prediction in patients with colon cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 306-309.

目的

分析结肠癌患者CT肿瘤体积测量参数结合实验室指标在术前分期预判中的应用价值。

方法

选取肥城市人民医院2021年3月至2023年9月收治的75例结肠癌患者。以病理检查结果为金标准，将患者按照pTNM分期分别纳入Ⅰ～Ⅱ期组、Ⅲ～Ⅳ期组。测量各组患者CT肿瘤体积参数，包括肿瘤长度（Tlen）、肿瘤最大径（Tdia）、肿瘤最大面积（Tare）和肿瘤体积（Tvol），并检测血脂、凝血指标、血清白蛋白（ADL）、乳酸脱氢酶与白蛋白比值（LAR）。归纳不同pTNM分期结肠癌患者差异指标，使用受试者工作特征曲线（ROC）绘制各项指标单独及联合评估结肠癌分期的曲线下面积（AUC）并计算预判效能。

结果

75例结肠癌患者中，Ⅰ期11例、Ⅱ期25例、Ⅲ期33例、Ⅳ期6例，Ⅰ～Ⅱ期、Ⅲ～Ⅳ期组基线资料比较，差异无统计学意义（P>0.05）。Ⅰ～Ⅱ期组Tlen、Tdia、Tare、Tvol均较Ⅲ～Ⅳ期组更低（P<0.05）。Ⅰ～Ⅱ期、Ⅲ～Ⅳ期组血脂水平比较，差异无统计学意义（P>0.05），Ⅰ～Ⅱ期组凝血指标（PT、APTT、FIB、D-D）、LAR均较Ⅲ～Ⅳ期组更低（P<0.05）。各项指标联合预判结肠癌患者分期的AUC为0.880，灵敏度、特异性分别为94.44%、82.05%。

结论

结肠癌患者分期的进展伴随着CT肿瘤体积测量参数、凝血指标、LAR的变化，联合上述指标能够为术前分期预判提供可靠参考。

关键词: 结肠癌, 肿瘤体积, 血脂, 凝血, 白蛋白, 肿瘤分期
Objective

To analyze the application value of CT tumor volume measurement parameters combined with preoperative laboratory indexes in preoperative staging prediction.

Methods

A total of 75 patients with colon cancer admitted in Feicheng People's Hospital from March 2021 to September 2023 were selected. Taking the pathological examination results as the gold standard, the patients were divided into stage Ⅰ-Ⅱ group and stage Ⅲ-Ⅳ group according to pTNM stages. The parameters of CT tumor volume, including tumor length (Tlen), tumor maximum diameter (Tdia), tumor maximum area (Tare) and tumor volume (Tvol), were measured, and their blood lipids, coagulation indexes and serum albumin (ADL) were detected, and lactate dehydrogenase to albumin ratio (LAR) was calculated. The different indexes of patients with different pTNM stages of colon cancer were summarized, the area under the curve (AUC) of each index to evaluate colon cancer stages individually and jointly were drawn using receiver operating characteristic curve (ROC), and the predictive efficiency was calculated.

Results

Among 75 patients with colon cancer, there were 11 cases in stage Ⅰ, 25 cases in stage Ⅱ, 33 cases in stage Ⅲ and 6 cases in stage Ⅳ. There was no significant difference in baseline data between stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ groups (P>0.05). Tlen, Tdia, Tare and Tvol in stage Ⅰ-Ⅱ group were lower than those in stage Ⅲ-Ⅳ group (P<0.05). There was no significant difference in blood lipid levels between stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ groups (P>0.05). The coagulation indexes (PT, APTT, FIB and D-D) and LAR in Ⅰ-Ⅱ stage group were lower than those in Ⅲ-Ⅳ stage group (P<0.05). The AUC of predicting the staging of colon cancer patients by combining all the indexes was 0.880, and the sensitivity and specificity were 94.44% and 82.05%, respectively.

Conclusion

The progress of staging of colon cancer patients is accompanied by the changes of CT tumor volume measurement parameters, coagulation indexes and LAR. The combination of the above indexes can provide reliable reference for preoperative staging prediction.

Key words: Colon cancer, Tumor volume, Blood lipids, Coagulation, Albumin, Stages
表1 2组结肠癌患者基线资料比较
组别 例数 年龄(岁,±s) 性别[例(%)] 病灶部位[例(%)] 组织学类型[例(%)]
男 女 升结肠 横结肠 其他 腺癌 其他
Ⅰ~Ⅱ期组 36 60.95±5.25 23(63.89) 13(36.11) 15(41.67) 12(33.33) 9(25.00) 28(77.78) 8(22.22)
Ⅲ~Ⅳ期组 39 61.33±5.41 24(61.54) 15(38.46) 19(48.72) 10(25.64) 10(25.64) 31(79.49) 8(20.51)
t/χ2值   0.308 0.044 0.586 0.033
P值   0.759 0.833 0.746 0.857
表2 2组结肠癌患者CT肿瘤体积测量参数比较（±s）
组别 例数 Tlen(cm) Tdia(cm) Tare(cm2) Tvol(cm3)
Ⅰ~Ⅱ期组 36 4.29±0.67 1.53±0.38 8.89±1.23 25.66±5.29
Ⅲ~Ⅳ期组 39 6.17±0.89 2.08±0.46 16.17±1.54 56.81±8.91
t值   10.268 5.619 22.499 18.216
P值   <0.001 <0.001 <0.001 <0.001
表3 2组结肠癌患者术前实验室指标比较（±s）
组别 例数 TC(mmol/L) TG(mmol/L) HDL-C(mmol/L) LDL-C(mmol/L) PT(s) APTT(s)
Ⅰ~Ⅱ期组 36 4.51±0.19 1.44±0.12 1.30±0.08 2.47±0.13 13.65±1.59 36.81±3.52
Ⅲ~Ⅳ期组 39 4.56±0.22 1.45±0.19 1.32±0.06 2.52±0.19 17.81±2.81 46.71±4.89
t值   1.049 0.270 1.231 1.319 7.802 9.989
P值   0.297 0.788 0.222 0.191 <0.001 <0.001
组别 例数 FIB(g/L) D-D(mg/L) LDH(U/L) ALB(g/L) LAR
Ⅰ~Ⅱ期组 36 5.17±0.36 0.47±0.11 171.83±26.95 40.15±4.76 4.28±0.43
Ⅲ~Ⅳ期组 39 7.22±1.51 1.08±0.26 224.69±31.38 40.04±4.91 5.61±0.69
t值   7.936 13.036 7.795 0.098 9.920
P值   <0.001 <0.001 <0.001 0.922 <0.001
图1 各项指标预判结肠癌患者分期的ROC曲线
表4 各项指标预判结肠癌患者分期的效能分析（%）
指标 截断值 AUC 灵敏度 特异性
CT肿瘤测量体积 Tlen≥5.10 cm 0.707 77.78 64.10
Tdia≥1.74 cm
Tare≥13.19 cm2
Tvol≥40.07 cm3
(≥2项指标达到截断值判定为阳性)
凝血指标 PT≥15.71 s 0.667 94.44 41.03
APTT≥42.15 s
FIB≥6.53 g/L
D-D≥0.84 mg/L
(≥2项指标达到截断值判定为阳性)
LDH及LAR LDH≥195.48 U/L 0.747 86.11 64.10
LAR≥5.22
(≥1项指标达到截断值判定为阳性)
联合 ≥1项指标阳性 0.880 94.44 82.05
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