术前能谱CT扫描参数联合肿瘤标志物对胃癌患者预后评估价值的研究

Study on the preoperative dual-energy CT scan parameters combined with tumor markers for prognostic assessment in gastric cancer patients

摘要:

目的 探讨术前能谱CT扫描参数联合肿瘤标志物对胃癌患者预后评估的价值。方法 选取2020年12月—2022年6月榆林市第一医院收治的159例胃癌患者。所有患者行胃癌切除术，术后随访2年。因治疗方案改变脱落5例，病情变化脱落3例，没有完成随访脱落5例，最终纳入146例。41例肿瘤复发、肿瘤转移、死亡患者为预后不良组，其余105例为预后良好组。收集所有患者的临床资料；所有患者术前接受能谱CT扫描，记录动脉期和静脉期的碘浓度（IC）及标准化碘基值（nIC）；检测术前血清肿瘤标志物癌胚抗原（CEA）和肿瘤特异性生长因子（TSGF）水平。采用多因素一般Logistic回归模型分析预后的影响因素，建立列线图预测模型并进行验证。结果 预后不良组患者的CT平扫值、动脉期和静脉期IC、动脉期和静脉期nIC均高于预后良好组（P <0.05）。多因素一般Logistic回归分析结果表明，CT平扫值［O^R =2.073（95% CI：1.006，4.272）］、动脉期IC［O^R =3.156（95% CI：1.476，6.706）］、静脉期IC［O^R =3.069（95% CI：1.494，6.303）］、动脉期nIC［O^R =2.304（95% CI：1.076，4.933）］、静脉期nIC［O^R =2.016（95% CI：1.014，4.011）］、CEA水平［O^R =4.338（95% CI：1.852，10.162）］和TSGF水平［O^R =2.222（95% CI：1.103，4.475）］均是影响患者预后不良的危险因素（P <0.05）。校准曲线的平均绝对误差为0.027，表明模型的预测准确度高，预测误差小。结论 胃癌患者术前行能谱CT扫描和肿瘤标志物水平检测有助于评估预后情况。

Abstract:

Objective To explore the applicational value of preoperative dual-energy CT scan parameters combined with tumor markers levels in assessing the prognosis of patients with gastric cancer.Methods The study included 159 gastric cancer patients treated at our institution from December 2020 to June 2022, all of whom underwent gastrectomy. A two-year follow-up was conducted post-surgery, 5 were dropped due to changes in treatment plans, 3 due to disease progression, and 5 due to incomplete follow-up. Ultimately, 146 cases were included for statistical analysis. 41 patients experiencing recurrence, metastasis, or death classified into the poor prognosis group, while other 105 patients were classified as the good prognosis group. Patient demographics were collected, and all patients underwent a preoperative dual-energy CT scan, recording parameters such as CT plain scan value, arterial phase iodine concentration (arterial IC), venous phase iodine concentration (venous IC), arterial phase normalized iodine value (arterial nIC), and venous phase normalized iodine value (venous nCI). Preoperative serum levels of carcinoembryonic antigen (CEA) and tumor-specific growth factor (TSGF) were also measured. Logistic regression analysis was used to explore the relationship between dual-energy CT scan parameters, tumor markers levels, and patient prognosis, and a nomogram prediction model was established.Results Comparisons of plain CT values, arterial and venous phase IC, arterial nIC, and venous nIC between groups with good and poor prognosis, were statistically significant (P < 0.05); patients in the poor prognosis group had higher values in all these measures. Multivariable analysis indicated that plain CT value [O^R = 2.073 (95% CI: 1.006, 4.272) ], arterial phase IC [O^R = 3.156 (95% CI: 1.476, 6.706) ], venous phase IC [O^R = 3.069 (95% CI: 1.494, 6.303) ], arterial phase nIC [O^R = 2.304 (95% CI: 1.076, 4.933) ], venous phase nIC [O^R = 2.016 (95% CI: 1.014, 4.011) ], CEA level [O^R = 4.338 (95% CI: 1.852, 10.162) ], and TSGF level [O^R = 2.222 (95% CI: 1.103, 4.475) ] were risk factors for poor prognosis (P < 0.05). The calibration curve showed a mean absolute error of 0.027, indicating high predictive accuracy and low prediction error of the model.Conclusion Preoperative dual-energy CT scanning and tumor markers level assessment are valuable for prognostic evaluation in gastric cancer patients.