本文選題：腎細胞癌 + 透明細胞癌　； 參考：《上海交通大學》2015年博士論文

【摘要】：目的:建立腎臟腫瘤在增強CT圖像上強化程度的測量方法,研究腎透明細胞癌強化特征與腫瘤Fuhrman分級的關系。對象和方法:回顧性分析255例住院接受腎癌根治術或腎臟部分切除術的腎透明細胞癌患者,獲取其臨床一般資料、多期增強CT圖像和手術標本病理檢查結(jié)果。在增強CT圖像上測量、記錄相關影像學特征及參數(shù),包括腫瘤最大徑、腫瘤強化特征、是否存在腫瘤內(nèi)鈣化、是否為囊性病灶、腫瘤邊緣光整度等。建立腎臟腫瘤強化程度的測量方法,定義代表強化程度的四個指標(TEV1、REV1、TEV2、REV2),研究強化指標與腎透明細胞癌Fuhrman分級之間的關系及其對后者的預測。將影像學特征、參數(shù)以及相關臨床一般資料納入多因素分析,尋找與腫瘤高Fuhrman分級相關的獨立因素。前瞻性納入45例透明細胞癌患者對前述所得結(jié)論進行驗證。結(jié)果:255例腎透明細胞癌患者中位年齡59歲,其中男性196例(76.9%),女性59例(23.1%),腫瘤最大徑中位數(shù)4.4cm。Fuhrman分級1-4級分別為24例(9.4%)、188例(73.7%)、40例(15.7%)、3例(1.2%)。四個強化指標在不同F(xiàn)uhrman分級之間存在顯著的組間差異(p0.001),隨著Fuhrman分級升高,四個強化指標均呈現(xiàn)下降趨勢。高級別(Fuhrman 3-4級)透明細胞癌的TEV1、REV1、TEV2、REV2值均顯著低于低級別(Fuhrman 1-2級)透明細胞癌(p0.001)。使用強化指標對腫瘤Fuhrman分級的高低進行預測,ROC曲線圖中TEV1、REV1、TEV2、REV2的曲線下面積分別為0.882、0.926、0.847、0.871。以0.65為臨界值,REV1對高Fuhrman分級預測的敏感度和特異度分別為0.84、0.93。將REV1值與其他臨床、影像學變量納入多因素分析,作為腫瘤Fuhrman分級高低的預測因素,logistic回歸顯示,患者高齡、腫瘤邊緣不規(guī)則和低REV1值為腫瘤高Fuhrman分級的獨立預測因素。在驗證隊列中,REV1≤0.65對高Fuhrman分級預測的敏感度和特異度分別為0.83、0.87。結(jié)論:腎透明細胞癌在增強CT上的強化程度與Fuhrman分級呈負相關,患者高齡、腫瘤邊緣不規(guī)則以及腫瘤低強化,構成腎透明細胞癌高Fuhrman分級的獨立預測因素。該評估方法有助于腎臟腫瘤的侵襲性評估,對臨床決策可能具有指導意義。
[Abstract]:Objective: to study the relationship between enhancement characteristics of renal clear cell carcinoma and Fuhrman grade of renal tumor. Participants and methods: 255 cases of renal clear cell carcinoma who underwent radical nephrectomy or partial nephrectomy were retrospectively analyzed. The clinical data, multiphase enhanced CT images and pathological findings of the specimens were obtained. The imaging features and parameters were recorded on enhanced CT images, including tumor maximum diameter, tumor enhancement, calcification in tumor, cystic lesion, margin light integration and so on. To establish a method to measure the degree of enhancement of renal tumors, and to define four indicators representing the degree of enhancement: TEV1 / REV1 / TEV2 / REV2. To study the relationship between enhancement and Fuhrman grade of renal clear cell carcinoma (RCC) and the prediction of the latter. Imaging features, parameters and general clinical data were included in multivariate analysis to find the independent factors associated with high Fuhrman grade of tumor. A prospective study of 45 patients with clear cell carcinoma was performed to verify the above conclusions. Results the median age of 255 cases of renal clear cell carcinoma was 59 years old. Among them, 196 cases were male (76. 9%) and 59 cases were female (23. 1%). The median 4.4cm.Fuhrman grade 1-4 of the median diameter of the tumor was 24 cases (9. 4%) respectively. There were significant differences among the four enhancement indexes among different Fuhrman grades, and with the increase of Fuhrman grading, the four enhancement indexes showed a downward trend. The values of TEV1, REV1, TEV2 and REV2 were significantly lower than those of low grade Fuhrman 1-2) of clear cell carcinoma (P 0.001). The area under the curve of TEV1 / REV1 / TEV2 / REV2 was 0.8820.92 / 0.926 / 0.847 / 0.871respectively, using the enhancement index to predict the level of tumor Fuhrman grade in the curve of TEV1 / REV1 / TEV2REV2 / REV2 / REV2 / REV2, respectively. The sensitivity and specificity of 0. 65 as the critical value for high Fuhrman grade prediction were 0. 84 and 0. 93 respectively. REV1 and other clinical and imaging variables were included in the multivariate analysis. As a predictor of tumor Fuhrman grade, the elderly patients, irregular tumor margin and low REV1 were independent predictors of high Fuhrman grade. In the validation cohort, the sensitivity and specificity of REV1 鈮，

本文編號：1881861