治疗前多期增强CT预测局部进展期胃癌肿瘤退缩分级与生存
该回顾性研究纳入116例接受新辅助化疗后胃切除术的局部进展期胃腺癌患者，评估治疗前多期增强CT定量参数预测肿瘤退缩分级（TRG）及生存的能力。静脉期肿瘤衰减和动脉期归一化强化率是TRG的独立预测因子，临床-影像联合模型平均AUC达0.869；静脉期和延迟期归一化强化率较高与总生存期较差相关。
要点
- 静脉期肿瘤衰减和动脉期归一化强化率可独立预测新辅助化疗后TRG反应。
- 临床-影像联合模型预测TRG的AUC为0.869，优于单独临床或影像模型。
- 静脉期和延迟期归一化强化率较高与总生存期较差相关。
核心结论
- 治疗前多期增强CT定量特征可预测局部进展期胃癌新辅助化疗后的TRG反应，联合临床-影像模型可提高预测性能。
- 静脉期和延迟期归一化强化率较高与总生存期较差相关，支持治疗前风险分层。
研究设计与样本
- 定量影像变量包括各期肿瘤衰减、归一化强化差值、归一化强化率、肿瘤面积和强化模式。
- TRG采用Mandard系统评估手术标本，TRG 1-2为应答者，TRG 3-5为无应答者。
- 采用单因素分析和Spearman相关筛选变量，纳入加权多变量逻辑回归并进行5折交叉验证。
- 采用单因素Cox和Kaplan-Meier分析评估与总生存期的关联。
诊断标准与关键数值
- 静脉期肿瘤衰减（OR=8.809，95%CI：2.134-36.358，P=0.003）和动脉期归一化强化率（OR=3.200，95%CI：1.365-7.504，P=0.007）独立预测TRG反应。
- 临床模型、影像模型和联合模型的平均AUC分别为0.746、0.807和0.869。
- 联合模型总体判别最佳，准确度0.759，敏感度0.703，特异度0.787，校准良好。
- 较高的静脉期归一化强化率（HR=1.01，P=0.004）和延迟期归一化强化率（HR=1.01，P=0.043）与较差的总生存期相关。
- CA199、CEA和年龄为独立临床预测因子。
临床应用与阅片要点
- 治疗前增强CT的静脉期肿瘤衰减和动脉期归一化强化率可用于辅助预测新辅助化疗后TRG反应。
- 联合临床因素（CA199、CEA、年龄）与影像定量特征可提高预测性能，支持治疗前风险分层。
- 静脉期和延迟期归一化强化率较高提示总生存期较差，阅片时可关注强化程度。
局限性
- 回顾性研究设计。
- 单中心研究。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: Reliable pretreatment prediction of pathological response remains a major challenge in locally advanced gastric cancer (LAGC). This study evaluated whether quantitative parameters from multiphasic contrast-enhanced CT (CECT) can predict tumor regression grade (TRG) after neoadjuvant chemotherapy (NAC) and provide prognostic information.
METHODS: We retrospectively analyzed 116 patients with cT2-4NxM0 gastric adenocarcinoma treated with NAC treatment followed by gastrectomy between January 2019 and December 2024. Quantitative imaging variables included phase-specific tumor attenuation ([Formula: see text], normalized enhancement difference ([Formula: see text]), normalized enhancement rate ([Formula: see text]), tumor area, and enhancement pattern. TRG was assessed on surgical specimens using the Mandard system; responders were defined as TRG 1-2 and non-responders as TRG 3-5. Candidate variables were screened by univariate analysis and Spearman correlation, then enrolled into weighted multivariable logistic regression with 5-fold cross-validation. Associations with overall survival were evaluated using univariate Cox and Kaplan-Meier analyses.
RESULTS: Forty-one patients were responders and 75 were non-responders. CA199, CEA, and age were independent clinical predictors. Among imaging features, venous-phase tumor attenuation ([Formula: see text]; OR = 8.809, 95% CI: 2.134-36.358, P = 0.003) and arterial-phase normalized enhancement rate ([Formula: see text]; OR = 3.200, 95% CI: 1.365-7.504, P = 0.007) independently predicted TRG response. The clinical, imaging, and combined models achieved mean AUCs of 0.746, 0.807, and 0.869, respectively; the combined model showed the best overall discrimination (accuracy 0.759, sensitivity 0.703, specificity 0.787) with good calibration. Higher [Formula: see text] (HR = 1.01, P = 0.004) and [Formula: see text] (HR = 1.01, P = 0.043) were associated with worse overall survival.
CONCLUSION: Pretreatment CECT-derived quantitative features can predict TRG response in LAGC, and a combined clinical-imaging model improves predictive performance. Higher normalized enhancement rates in the venous and delayed phases are associated with poorer overall survival, supporting pre-treatment risk stratification in clinical practice.
引用
- Hu Y, Xia M, Zou L, et al. Pretreatment multiphasic contrast-enhanced CT predicts tumor regression grade and survival in locally advanced gastric cancer. Abdom Radiol (NY). 2026. PMID: 42008173. doi:10.1007/s00261-026-05523-z
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。