术前增强CT在评估结直肠癌微卫星不稳定性中的价值

王慧慧; 赵可; 许泽艳; 彭海恩; 梁长虹; 刘再毅

doi:10.19732/j.cnki.2096-6210.2022.02.004

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术前增强CT在评估结直肠癌微卫星不稳定性中的价值

专题论著 | 更新时间：2025-12-15

- 术前增强CT在评估结直肠癌微卫星不稳定性中的价值
- The value of contrast-enhanced CT in assessing microsatellite instability with colorectal cancer
- 肿瘤影像学 2022年31卷第2期页码：121-129
- 作者机构：
  
  广东省人民医院（广东省医学科学院）放射科,广东,广州,510080
- 作者简介：
- 基金信息：
  
  国家重点研发计划（2021YFF1201003）;国家杰出青年科学基金（81925023）;国家自然科学基金（82071892）;广东省重点领域研发计划项目（2021B0101420006）;高水平医院建设科研专项（DFJH201805，DFJHBF202105）
- DOI：10.19732/j.cnki.2096-6210.2022.02.004
  中图分类号：
- 网络出版：2022-04-28，
  
  纸质出版：2022-04-28
- 稿件说明：
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王慧慧,赵可,许泽艳,等. 术前增强CT在评估结直肠癌微卫星不稳定性中的价值[J]. 肿瘤影像学, 2022, 31(2): 121-129 https://doi.

org/10.19732/j.cnki.2096-6210.2022.02.004
王慧慧,赵可,许泽艳,等. 术前增强CT在评估结直肠癌微卫星不稳定性中的价值[J]. 肿瘤影像学, 2022, 31(2): 121-129 https://doi. DOI： 10.19732/j.cnki.2096-6210.2022.02.004.

org/10.19732/j.cnki.2096-6210.2022.02.004 DOI：

摘要

目的：

分析结直肠癌（colorectal cancer，CRC）患者术前增强计算机体层成像（computed tomography，CT）影像学特征与微卫星不稳定性（microsatellite instability，MSI）及预后的关系。

方法：

收集2010年3月2016年3月的CRC患者术前增强CT图像及临床病理学信息，并将所有患者按照1∶1随机分配至训练组和验证组。评估的增强CT影像学特征包括肿瘤位置、肿瘤内低密度占比、强化程度、强化形式和肠壁增厚形式。使用单因素及多因素logistic回归分析临床及CT特征与MSI的关系，用受试者工作特征曲线的曲线下面积（area under curve，AUC）分析特征对CRC患者MSI的预测价值。采用Kaplan-Meier方法进行生存分析。

结果：

共纳入382例CRC患者，10.5%（40例）为MSI，89.5%（342例）为微卫星稳定性（microsatellite stability，MSS）。单因素分析中，训练组和验证组的4个影像学特征（包括肿瘤位置、低密度占比、强化程度以及强化形式）在MSI和MSS组中差异均有统计学意义（

＜0.05）。多因素分析结果显示，肿瘤位置、低密度占比是CRC患者MSI的独立预测指标（左半结肠或直肠组vs右半结肠组，OR值0.20，95% CI 0.07~0.54，

=0.002；低密度占比＞2/3组vs低密度占比＜1/3组，OR值9.36，95% CI 2.83~31.0，

＜0.001）。结合肿瘤位置和低密度占比构建的预测模型在训练组和验证组的AUC分别为0.80（95% CI 0.70~0.90）、0.75（95% CI 0.63~0.87）。此外，在左半结肠或直肠组中，低密度占比-低组和低密度占比-高组的患者5年生存率分别为75.7%、56.2%，差异有统计学意义（

=0.004）。

结论：

增强CT肿瘤低密度占比结合肿瘤位置可用于预测CRC患者MSI以及评估预后。

Abstract

Objective:

To evaluate the value of contrast-enhanced computed tomography (CT) in assessing microsatellite instability (MSI) and

prognosis of colorectal cancer (CRC).

Methods:

The preoperative contrast-enhanced CT images and medical records of CRC patients from March 2010 to March 2016 were collected and retrospectively reviewed. According to the ratio of 1∶1

the patients were divided into the training set and test set by computer random software. CT signs were analyzed

including tumor location

the ratio of low-density area

enhancement degree

enhancement form

and intestinal wall thickening form. Univariate and multivariate logistic regression analyses were performed to assess the relationship between all variables and MSI. Areas under the curve (AUC) were used to estimate the predictive performance of variables. Survival analyses were performed using the Kaplan- Meier method.

Results:

Of the 382 CRC cases

MSI was identified in 40 cases (10.5%)

and microsatellite stability (MSS) was identified in 342 cases (89.5%). In the univariate logistic regression analysis

tumor location

the ratio of low-density area

enhancement degree

and enhancement form showed significant differences between the MSI group and the MSS group in CRC (all

＜0.05). In the multivariate logistic regression analysis

tumor location and the ratio of low-density area showed significant differences between the MSI group and the MSS group in CRC (left-side location group vs right-side location group

OR was 0.20

95% CI 0.07-0.54

=0.002; the ratio of low-density area was greater than or equal to 2/3 vs the ratio of low-density area was less than 1/3

OR was 9.36

95% CI 2.83-31.0

＜0.001). The AUC value of the combination of tumor location and ratio of low-density area was 0.80 (95% CI 0.70-0.90) in the training set and 0.75 (95% CI 0.63-0.87) in the test set. In the left-side location group

the 5-year overall survival of low ratio of low-density area and high ratio of low-density area were 75.7% and 56.2%

respectively (

=0.004).

Conclusion:

The model combined ratio of low-de

nsity area and tumor location can predict MSI and assess the prognosis for CRC patients.

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