• 1.四川大學(xué)華西醫(yī)院肛腸外科(成都 610041);;
  • 2.四川大學(xué)華西臨床醫(yī)學(xué)院(成都 610041);;
  • 3.四川大學(xué)華西醫(yī)院放射科(成都 610041);

目的  建立聯(lián)合纖維蛋白原(FIB)水平的最佳形態(tài)學(xué)標(biāo)準(zhǔn)評(píng)估結(jié)直腸癌術(shù)前淋巴結(jié)轉(zhuǎn)移。
方法  納入連續(xù)的690例接受根治術(shù)的結(jié)直腸癌患者,所有患者術(shù)前均使用多層螺旋CT(MSCT)行全腹增強(qiáng)掃描。若發(fā)現(xiàn)異常局域淋巴結(jié)則測(cè)量其最大短軸軸徑(MSAD)、最大長軸軸徑(MLAD)以及軸徑比(MSAD/MLAD),并計(jì)算每個(gè)分界值預(yù)測(cè)結(jié)直腸癌淋巴結(jié)轉(zhuǎn)移的準(zhǔn)確度、敏感度、特異度、陽性預(yù)測(cè)值和陰性預(yù)測(cè)值; 聯(lián)合術(shù)前血清FIB水平鑒別轉(zhuǎn)移性或炎性淋巴結(jié); MSCT聯(lián)合FIB和單用MSCT兩種策略的預(yù)測(cè)結(jié)果 與術(shù)后病理檢查結(jié)果 進(jìn)行比較。
結(jié)果  本研究納入有異常淋巴結(jié)顯示的患者100例,其中轉(zhuǎn)移性淋巴結(jié)與非轉(zhuǎn)移性淋巴結(jié)的影像特點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。MSAD的最佳分界值為6 mm,其診斷淋巴結(jié)轉(zhuǎn)移的敏感度為46.8%,特異度為68.4%,準(zhǔn)確度為55.0%,陽性預(yù)測(cè)值為70.7%,陰性預(yù)測(cè)值為44.1%。MLAD的最佳分界值為8 mm,其診斷淋巴結(jié)轉(zhuǎn)移的敏感度為43.5%,特異度為63.2%,準(zhǔn)確度為51.0%,陽性預(yù)測(cè)值為65.9%,陰性預(yù)測(cè)值為40.7%。以高纖維蛋白原血癥(FIB≥3.5 g/L)鑒別診斷MSAD lt;6 mm或MLAD lt;8 mm的轉(zhuǎn)移性小淋巴結(jié),其診斷價(jià)值有統(tǒng)計(jì)學(xué)意義(Kappa=0.256,P=0.047)。MSAD(6 mm)聯(lián)合高纖維蛋白原血癥與單用MSAD(6 mm)相比敏感度更高 (79.0%比46.8%,P lt;0.001),但準(zhǔn)確度相似 (66.0%比55.0%,P gt;0.05),特異度更低(44.7%比68.4%,P=0.037)。與單用MLAD(8 mm)相比,聯(lián)合高纖維蛋白原血癥敏感度(80.6%比43.5%,P lt;0.001)和準(zhǔn)確度 (66.0%比51.0%,P=0.031)都更高,且特異度沒有明顯降低(42.1%比63.2%,P gt;0.05)。
結(jié)論  本研究推薦采用MSAD≥6 mm或MLAD≥8 mm作為結(jié)直腸癌淋巴結(jié)轉(zhuǎn)移的診斷標(biāo)準(zhǔn)。此外,聯(lián)合高纖維蛋白原血癥對(duì)淋巴結(jié)轉(zhuǎn)移進(jìn)行鑒別,可以提高術(shù)前分期的敏感度和準(zhǔn)確度。

引用本文: 汪曉東,歐陽書睿,呂東昊,莊磊,蔣善明,鄧?yán)?李崢艷,李立. 纖維蛋白原聯(lián)合多層螺旋CT術(shù)前預(yù)測(cè)結(jié)直腸癌淋巴結(jié)轉(zhuǎn)移. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(9): 757-762. doi: 復(fù)制

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1. Lafreniere R. What’s new in general surgery: surgical oncology [J]. J Am Coll Surg, 2004; 198(6): 966-988.
2. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322-326.
3. Dworák O. Number and size of lymph nodes and node metastases in rectal carcinomas [J]. Surg Endosc, 1989; 3(2): 96-99.
4. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [J]. Lancet, 1986; 6(6): 579-581.
5. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [J]. Dig Dis, 2007; 25(1): 20-32.
6. 汪曉東, 劉丹, 呂東昊, 等. 術(shù)前纖維蛋白原水平與結(jié)直腸癌病理分期的關(guān)系 [J]. 中華實(shí)用診斷與治療雜志, 2009; 23(7): 643- 645.
7. 汪曉東, 高強(qiáng), 周小雁, 等. 多層螺旋CT聯(lián)合纖維蛋白原或血清淀粉樣蛋白A對(duì)直腸癌外科決策的隨機(jī)對(duì)照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 575-580.
8. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
9. Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound [J]. J Comput Assist Tomogr, 2004; 28(1): 123-130.
10. Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma [J]. Radiology, 1983; 149(1): 241-246.
11. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [J]. Dis Colon Rectum, 1986; 29(7): 446-450.
12. Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer [J]. Br J Surg, 2008; 95(1): 92-96.
13. Theoni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [J]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
14. Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma [J]. Am J Surg, 2002; 184(2): 131-135.
15. McCormick JT, Gregorcyk SG. Preoperative evaluation of colorectal cancer [J]. Surg Oncol Clin N Am, 2006; 15(1): 39-49.
16. Pomerri F, Maretto I, Pucciarelli S, et al. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement [J]. Eur J Surg Oncol, 2009; 35(2): 168-173.
17. Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [J]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
18. 王瓊, 謝嶸, 張青云, 等. 結(jié)直腸癌患者血漿纖維蛋白原的檢測(cè)及其臨床意義 [J]. 中華腫瘤雜志, 2005; 27(9): 544-546.
19. Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [J]. Cancer Metastasis Rev, 1992; 11(3-4): 283-290.
20. Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous he-matogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice [J]. Cancer Res, 2002; 62(23): 6966-6972.
21. Rickles FR, Hancock WW, Edwards RL, et al. Antimetastatic agents. Ⅰ. Role of cellular procoagulants in the pathogenesis of fibrin deposition in cancer and the use of anticoagulants and/or antiplatelet drugs in cancer treatment [J]. Semin Thromb Hemost, 1988; 14(1): 88-94.
22. 汪曉東, 張瓊文, 呂東昊, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估結(jié)腸癌對(duì)手術(shù)方案選擇的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(3): 232-237.
23. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 404-409.
24. 吳俊華, 汪曉東, 高強(qiáng), 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估下段直腸癌對(duì)手術(shù)方案選擇的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(2): 156-161.
25. 汪曉東, 呂東昊, 宋歡, 等. 多模式術(shù)前評(píng)估系統(tǒng)對(duì)中低位直腸癌手術(shù)方案選擇的價(jià)值: 一項(xiàng)隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(6): 487-492.
  1. 1. Lafreniere R. What’s new in general surgery: surgical oncology [J]. J Am Coll Surg, 2004; 198(6): 966-988.
  2. 2. 汪曉東, 宋歡, 呂東昊, 等. 術(shù)前聯(lián)合評(píng)估直腸上段癌與手術(shù)方案選擇的隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 322-326.
  3. 3. Dworák O. Number and size of lymph nodes and node metastases in rectal carcinomas [J]. Surg Endosc, 1989; 3(2): 96-99.
  4. 4. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer [J]. Lancet, 1986; 6(6): 579-581.
  5. 5. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer [J]. Dig Dis, 2007; 25(1): 20-32.
  6. 6. 汪曉東, 劉丹, 呂東昊, 等. 術(shù)前纖維蛋白原水平與結(jié)直腸癌病理分期的關(guān)系 [J]. 中華實(shí)用診斷與治療雜志, 2009; 23(7): 643- 645.
  7. 7. 汪曉東, 高強(qiáng), 周小雁, 等. 多層螺旋CT聯(lián)合纖維蛋白原或血清淀粉樣蛋白A對(duì)直腸癌外科決策的隨機(jī)對(duì)照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 575-580.
  8. 8. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
  9. 9. Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer: assessment with double-contrast multislice computed tomography and transrectal ultrasound [J]. J Comput Assist Tomogr, 2004; 28(1): 123-130.
  10. 10. Grabbe E, Lierse W, Winkler R. The perirectal fascia: morphology and use in staging of rectal carcinoma [J]. Radiology, 1983; 149(1): 241-246.
  11. 11. Hodgman CG, MacCarty RL, Wolff BG, et al. Preoperative staging of rectal carcinoma by computed tomography and 0.15 T magnetic resonance imaging. Preliminary report [J]. Dis Colon Rectum, 1986; 29(7): 446-450.
  12. 12. Noji T, Kondo S, Hirano S, et al. Computed tomography evaluation of regional lymph node metastases in patients with biliary cancer [J]. Br J Surg, 2008; 95(1): 92-96.
  13. 13. Theoni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [J]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
  14. 14. Matsuoka H, Nakamura A, Masaki T, et al. Preoperative staging by multidetector-row computed tomography in patients with rectal carcinoma [J]. Am J Surg, 2002; 184(2): 131-135.
  15. 15. McCormick JT, Gregorcyk SG. Preoperative evaluation of colorectal cancer [J]. Surg Oncol Clin N Am, 2006; 15(1): 39-49.
  16. 16. Pomerri F, Maretto I, Pucciarelli S, et al. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement [J]. Eur J Surg Oncol, 2009; 35(2): 168-173.
  17. 17. Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [J]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
  18. 18. 王瓊, 謝嶸, 張青云, 等. 結(jié)直腸癌患者血漿纖維蛋白原的檢測(cè)及其臨床意義 [J]. 中華腫瘤雜志, 2005; 27(9): 544-546.
  19. 19. Costantini V, Zacharski LR. The role of fibrin in tumor metastasis [J]. Cancer Metastasis Rev, 1992; 11(3-4): 283-290.
  20. 20. Palumbo JS, Potter JM, Kaplan LS, et al. Spontaneous he-matogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice [J]. Cancer Res, 2002; 62(23): 6966-6972.
  21. 21. Rickles FR, Hancock WW, Edwards RL, et al. Antimetastatic agents. Ⅰ. Role of cellular procoagulants in the pathogenesis of fibrin deposition in cancer and the use of anticoagulants and/or antiplatelet drugs in cancer treatment [J]. Semin Thromb Hemost, 1988; 14(1): 88-94.
  22. 22. 汪曉東, 張瓊文, 呂東昊, 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估結(jié)腸癌對(duì)手術(shù)方案選擇的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(3): 232-237.
  23. 23. 汪曉東, 尹源, 陸玫竹, 等. 經(jīng)直腸超聲聯(lián)合血清淀粉樣蛋白A術(shù)前評(píng)估中低位直腸癌與手術(shù)決策的隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 404-409.
  24. 24. 吳俊華, 汪曉東, 高強(qiáng), 等. 64排多層螺旋CT和血清淀粉樣蛋白A聯(lián)合評(píng)估下段直腸癌對(duì)手術(shù)方案選擇的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(2): 156-161.
  25. 25. 汪曉東, 呂東昊, 宋歡, 等. 多模式術(shù)前評(píng)估系統(tǒng)對(duì)中低位直腸癌手術(shù)方案選擇的價(jià)值: 一項(xiàng)隨機(jī)對(duì)照試驗(yàn) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(6): 487-492.