经直肠超声多参数联合检测对中低位直肠癌淋巴结转移的术前预测价值

doi:10.3877/cma.j.issn.2095-2015.2026.03.004

目的

探讨经直肠超声（TRUS）多参数联合检测对中低位直肠癌淋巴结转移的术前精准预测价值。

方法

回顾性收集2022年3月至2024年3月汉中市人民医院接诊的200例中低位直肠癌患者病历，根据术后病理结果分为转移组（89例）和非转移组（111例）。所有患者术前均行TRUS检查，采集TRUS相关参数，采用受试者操作特征（ROC）曲线分析各参数及联合检测的预测效能。

结果

转移组患者的淋巴结长径、淋巴结短径、长短径比值均显著大于非转移组，直肠肿物占肠腔环周>1/2例数及超声T₃及以上分期比例均显著高于非转移组（P<0.05）；ROC曲线分析显示，淋巴结长径、淋巴结短径、长短径比值、直肠肿物占肠腔环周>1/2、超声T₃及以上分期联合检测的AUC、灵敏度、特异度均显著高于各指标单独检测（P<0.05）。

结论

基于TRUS多参数构建的联合预测模型可有效提高中低位直肠癌淋巴结转移的术前预测准确性，结合列线图可为临床病情评估及个体化治疗方案制定提供可靠参考。

关键词: 直肠癌, 经直肠超声检查, 淋巴结转移, 预测价值

Objective

To explore the preoperative precise predictive value of multi-parameter combined detection of transrectal ultrasound (TRUS) for lymph node metastasis of middle and low rectal cancer.

Methods

The medical records of 200 patients with middle and low rectal cancer who were treated in Hanzhong People's Hospital from March 2022 to March 2024 were retrospectively collected, according to the postoperative pathological results, they were divided into the metastasis group (89 cases) and the non-metastasis group (111 cases). All patients underwent TRUS examination before the operation, and TRUS-related parameters were collected, the predictive efficacy of each parameter and combined detection was analyzed using the receiver operating characteristic (ROC) curve.

Results

The long diameter of lymph nodes, short diameter of lymph nodes, and the ratio of long to short diameter in the metastasis group were significantly larger than those in the non-metastasis group, and the number of cases where rectal masses accounted for more than 1/2 of the intestinal lumen circumference and the number of cases with ultrasound T₃ or above stages were significantly higher than those in the non-metastasis group (P<0.05). ROC curve analysis showed that the AUC, sensitivity and specificity of combined detection of long diameter of lymph nodes, short diameter of lymph nodes, ratio of long to short diameter, rectal mass accounting for more than 1/2 of the intestinal lumen circumference, and ultrasound T₃ and above stages were significantly higher than those of individual detection of each index (P<0.05).

Conclusion

The joint prediction model constructed based on TRUS multi-parameters can effectively improve the preoperative prediction accuracy of lymph node metastasis in middle and low rectal cancer, combined with the nomogram, it can provide reliable references for clinical condition assessment and individualized treatment plan formulation.

Key words: Rectal cancer, Transrectal ultrasonography, Lymph node metastasis, Predictive value

表1 两组中低位直肠癌患者一般资料比较[例（%）]

指标	转移组(n=89)	非转移组(n=111)	t/χ²值	P值
男/女[例(%)]	51(57.30)/38(42.70)	61(54.95)/50(45.05)	0.111	0.740
年龄(岁,±s)	61.23±8.26	60.75±8.14	0.412	0.681
体重指数(kg/m²,±s)	22.34±2.45	21.98±2.28	1.073	0.284
病灶距肛门距离(cm,±s)	6.48±1.51	6.55±1.37	0.343	0.732
肿瘤位置(上段/下段)[例(%)]	29(32.58)/60(67.42)	39(35.14)/72(64.86)	0.143	0.705

表1 两组中低位直肠癌患者一般资料比较[例（%）]

指标	转移组(n=89)	非转移组(n=111)	t/χ²值	P值
男/女[例(%)]	51(57.30)/38(42.70)	61(54.95)/50(45.05)	0.111	0.740
年龄(岁,±s)	61.23±8.26	60.75±8.14	0.412	0.681
体重指数(kg/m²,±s)	22.34±2.45	21.98±2.28	1.073	0.284
病灶距肛门距离(cm,±s)	6.48±1.51	6.55±1.37	0.343	0.732
肿瘤位置(上段/下段)[例(%)]	29(32.58)/60(67.42)	39(35.14)/72(64.86)	0.143	0.705

表2 两组中低位直肠癌患者经直肠超声检查参数比较

指标	转移组(n=89)	非转移组(n=111)	t/χ²值	P值
淋巴结长径(mm,±s)	7.35±2.14	5.48±1.26	7.695	<0.0001
淋巴结短径(mm,±s)	6.42±1.18	5.21±1.05	7.664	<0.0001
长短径比值(±s)	1.15±0.27	1.03±0.22	3.464	<0.0001
直肠肿物占肠腔环周>1/2[例(%)]	68(76.40)	49(44.14)	21.175	<0.0001
超声T₃及以上分期[例(%)]	75(84.27)	58(52.25)	22.730	<0.0001

表2 两组中低位直肠癌患者经直肠超声检查参数比较

指标	转移组(n=89)	非转移组(n=111)	t/χ²值	P值
淋巴结长径(mm,±s)	7.35±2.14	5.48±1.26	7.695	<0.0001
淋巴结短径(mm,±s)	6.42±1.18	5.21±1.05	7.664	<0.0001
长短径比值(±s)	1.15±0.27	1.03±0.22	3.464	<0.0001
直肠肿物占肠腔环周>1/2[例(%)]	68(76.40)	49(44.14)	21.175	<0.0001
超声T₃及以上分期[例(%)]	75(84.27)	58(52.25)	22.730	<0.0001

图1 经直肠超声多参数联合检测对中低位直肠癌淋巴结转移的术前精准预测价值ROC分析

表3 经直肠超声多参数联合检测对中低位直肠癌淋巴结转移的术前精准预测价值

变量	cutoff	AUC(95% CI)	敏感度[%(95% CI)]	特异性[%(95% CI)]	与联合检测AUC的Delong检验P值
淋巴结长径	6.23 mm	0.684(0.612~0.756)	65.32(52.41~76.68)	68.47(57.12~78.23)	<0.0001
淋巴结短径	5.78 mm	0.692(0.620~0.763)	66.40(53.58~77.56)	69.38(58.15~79.03)	<0.0001
长短径比值	1.08	0.704(0.633~0.775)	67.86(55.12~78.79)	70.25(59.11~79.76)	<0.0001
直肠肿物占肠腔环周>1/2	6.23 mm	0.715(0.649~0.785)	69.21(56.58~79.98)	71.43(60.39~80.65)	<0.0001
超声T₃及以上分期	5.78 mm	0.729(0.660~0.797)	70.57(58.05~80.98)	72.69(61.75~81.63)	<0.0001
联合检测	1.08	0.913(0.852~0.974)	77.31(65.28~86.54)	82.46(72.63~90.01)	<0.0001

表3 经直肠超声多参数联合检测对中低位直肠癌淋巴结转移的术前精准预测价值

变量	cutoff	AUC(95% CI)	敏感度[%(95% CI)]	特异性[%(95% CI)]	与联合检测AUC的Delong检验P值
淋巴结长径	6.23 mm	0.684(0.612~0.756)	65.32(52.41~76.68)	68.47(57.12~78.23)	<0.0001
淋巴结短径	5.78 mm	0.692(0.620~0.763)	66.40(53.58~77.56)	69.38(58.15~79.03)	<0.0001
长短径比值	1.08	0.704(0.633~0.775)	67.86(55.12~78.79)	70.25(59.11~79.76)	<0.0001
直肠肿物占肠腔环周>1/2	6.23 mm	0.715(0.649~0.785)	69.21(56.58~79.98)	71.43(60.39~80.65)	<0.0001
超声T₃及以上分期	5.78 mm	0.729(0.660~0.797)	70.57(58.05~80.98)	72.69(61.75~81.63)	<0.0001
联合检测	1.08	0.913(0.852~0.974)	77.31(65.28~86.54)	82.46(72.63~90.01)	<0.0001

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Preoperative predictive value of multi-parameter combined transrectal ultrasound detection for lymph node metastasis of middle and low rectal cancer

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Preoperative predictive value of multi-parameter combined transrectal ultrasound detection for lymph node metastasis of middle and low rectal cancer