目的: 前瞻性评估双能量CT（dual-energy computed tomography, DECT）中的总碘摄取（total iodine uptake, TIU）在预测胃癌病人新辅助化疗疗效和无进展生存期（progression-free survival, PFS）的应用价值。方法: 收集我院44例化疗前、后均行DECT扫描的局部进展期胃癌病人。计算肿瘤面积（%ΔS）,直径（%ΔD）和密度（%ΔHU）的变化率来评估WHO、RESCIST和Choi标准。同时计算肿瘤体积（%ΔV）和门静脉期TIU的变化率（%ΔTIU-p）来评估ROC曲线下的界值。统计学分析不同标准与组织病理退缩分级（Becker）或PFS间的关系。结果: 分别根据ΔV（43.34%,P=0.002）和ΔTIU-p（63.87%,P=0.002）的界值将病人分为反应组和非反应组。%ΔTIU-p标准与Becker间显示较强的相关性（r=0.602,P<0.001）,%ΔV显示中等相关（r=0.416, P=0.005）,而WHO（r=0.075, P=0.627）, RECIST（r=0.270, P=0.077）和Choi标准（r=0.238, P=0.120）与Becker间无相关性。%ΔTIU-p（P=0.001）和Choi标准（P=0.013）的反应组和非反应组PFS间差异具有统计学意义。结论: TIU-p可预测进展期胃癌病人新辅助化疗后病理退缩。%ΔTIU-p分析新辅助化疗后的PFS有一定意义。
Objective To evaluate prospectively the total iodine uptake (TIU) from dual-energy computed tomography (DECT) in predicting treatment efficacy and progression-free survival (PFS) time in the patients with gastric cancers after neoadjuvant chemotherapy (NAC). Methods Forty-four patients with locally advanced gastric cancer were given DECT before and after NAC. Changes in percentage of tumor area (%ΔS), diameter (%ΔD), and density (%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. Changes in percentage of tumor volume (%ΔV) and TIU in portal phase (%ΔTIU-p) were also calculated to determine cut-off points by ROC curves. Correlations between criteria and histomorphologic tumor regression grade (Becker) and between criteria and PFS were analyzed. Results Patients were divided into responders group and non-responders group by ΔV (43.34%, P=0.002) and by ΔTIU-p (63.87%, P=0.002), respectively. Higher correlation was present between criteria %ΔTIU-p and Becker grade (r=0.602, P<0.001) and moderate correlation between criteria %ΔV and Becker grade (r=0.416, P=0.005), while no correlation between Becker grade and WHO criteria (r=0.075, P=0.627), RECIST criteria (r=0.270, P=0.077) and Choi criteria (r=0.238, P=0.120). There were statistical diffe-rences significantly in PFS time of the patients between responder group and non-responder group when using criteria %ΔTIU-p (P=0.001) or Choi criteria (P=0.013). Conclusions TIU-p could be used to predict pathological regression in patients with advanced gastric cancer after NAC. Criteria %ΔTIU-p would become the parameter to study PFS time after NAC.
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