高场强MRI联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期的价值分析

张德生; 朱晓雷; 何剑; 郑屹峰; 吴晓; 储海瑞; 郭东闯

doi:10.16766/j.cnki.issn.1674-4152.002555

高场强MRI联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.002555

1.
湖州市中心医院，湖州师范学院附属中心医院放射科，浙江湖州 313000
2.
上海交通大学医学院附属瑞金医院放射科, 上海 200025

基金项目:

浙江省医药卫生科技计划项目 2020KY303

详细信息

通讯作者:
朱晓雷, E-mail: mayomedical1@163.com

中图分类号: R735.1 R445.2
计量
- 文章访问数: 129
- HTML全文浏览量: 104
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-03-25
- 网络出版日期: 2022-09-23

Value of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 in identifying T staging of oesophageal cancer

1.
Department of Radiology, Affiliated Central Hospital of Huzhou Normal University, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的分析高场强MRI联合血清细胞角蛋白19片段(CYFRA21-1)、糖类抗原72-4(CA72-4)、癌症抗原125(CA125)鉴别食管癌T分期的价值。方法选取2017年7月—2020年1月在上海交通大学医学院附属瑞金医院、湖州市中心医院拟行手术治疗的食管癌患者104例为研究对象，分析高场强MRI的图像质量，高场强MRI及其联合血清CYFRA21-1、CA72-4、CA125，采用Kappa一致性分析鉴别食管癌T分期的价值。结果高场强MRI图片质量2分6例、3分16例、4分40例、5分42例；高场强MRI诊断食管癌T分期的准确率为92.30%(96/104)，高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断食管癌T分期的准确率为95.19%(99/104)，与单一MRI诊断食管癌T分期的准确率差异有统计学意义(P＜0.05)；但诊断T2分期的特异度、准确率、阳性预测值，诊断T3分期的敏感度、特异度、准确率、阳性预测值、阴性预测值，诊断T4a分期的敏感度、准确率、阴性预测值均较单一高场强MRI诊断上升。结论单一高场强MRI或联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期均可获得良好效能，联合诊断效能略有提升。
- 食管癌 /
- T分期 /
- 高场强MRI /
- 细胞角蛋白21-1 /
- 糖类抗原72-4 /
- 癌症抗原125
Abstract: Objective To analyse the value of high-strength MRI combined with serum cytokeratin 19 fragment (CYFRA21-1), carbohydrate antigen 72-4 (CA72-4) and carbohydrate antigen 125 (CA125) in identifying T staging of oesophageal cancer. Methods From July 2017 to January 2020, 104 patients with esophageal cancer who were to be surgically treated in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Huzhou Central Hospital were selected as research objects. The image quality of high-field-intensity MRI and the value of high-field-intensity MRI combined with serum CYFRA21-1, CA72-4, CA125 were analysed. Kappa consistency analysis was used in identifying T staging of oesophageal cancer. Results There were 6 cases with high-strength MRI image quality scoring 2 points, 16 cases scoring 3 points, 40 cases scoring 4 points and 42 cases scoring 5 points. The accuracy of high-strength MRI for the diagnosis of T staging of oesophageal cancer was 92.30% (96/104). The accuracy rate of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 for the diagnosis of T staging of oesophageal cancer was 95.19% (99/104), which was significantly different from that of single MRI (P < 0.05). However, the specificity, accuracy, positive predictive value for stage T2; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for stage T3; and sensitivity, accuracy, negative predictive value for stage T4a of combined diagnosis were higher than those of single high-strength MRI. Conclusion Single high-strength MRI or its combination with serum CYFRA21-1, CA72-4 and CA125 can effectively identify the T staging of oesophageal cancer, and the efficiency of combined diagnosis is slightly improved.
- Oesophageal cancer /
- T staging /
- High-strength MRI /
- Cytokeratin 21-1 /
- Carbohydrate antigen 72-4 /
- Carbohydrate antigen 125

HTML全文

表 1 高场强扫描序列及参数

Table 1. High field strength scanning sequence and parameters

参数	BLADE-TSE-T₂WI (膈肌导航)	DWI	radial-容积内插体部检查
层厚(mm)	3	3	3
TR(ms)	4 000~8 000	5 000	3.98
回波时间(ms)	97	55	1.91
脉冲重复激发次数	1		1
矩阵	256×256	128×128	288×288
视野(mm)	240×240	300×300	300×300
扫描时间(s)	360~600	157	309
b值(s/mm²)		0、700

下载: 导出CSV

表 2 高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断方法

Table 2. High-field MRI combined with serum CYFRA21-1, CA72-4, CA125 diagnostic methods

T分期	高场强MRI	血清肿瘤标志物
T1	阳性	CYFRA21-1阴性、CA72-4阴性、CA125阴性，至少满足任意1项
T2	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，至少满足任意1项
T3	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，至少满足任意2项
T4a	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，同时满足3项

下载: 导出CSV

表 3 高场强MRI诊断T分期结果与术后病理对照(例)

Table 3. The results of high-field MRI diagnosis of T staging and postoperative pathological comparison (cases)

T分期	高场强MRI诊断T分期				合计
T分期	T1	T2	T3	T4a	合计
T1	22	1	0	0	23
T2	0	26	0	0	26
T3	0	4	42	0	46
T4a	0	0	3	6	9
合计	22	31	45	6	104

下载: 导出CSV

表 4 高场强MRI对食管癌T分期的诊断价值(%)

Table 4. Diagnostic value of high-field MRI for T staging of esophageal cancer (%)

T分期	敏感度	特异度	准确率	阳性预测值	阴性预测值
T1	100.00	100.00	100.00	100.00	100.00
T2	100.00	93.58	95.19	83.87	100.00
T3	91.30	94.82	93.26	93.33	93.20
T4a	66.67	100.00	97.11	100.00	96.93

下载: 导出CSV

表 5 不同T分期的食管癌患者血清CYFRA21-1、CA72-4、CA125阳性情况[例(%)]

Table 5. Positive status of serum CYFRA21-1, CA72-4 and CA125 in patients with esophageal cancer in different T stages [cases (%)]

T分期	例数	CYFRA21-1阳性	CA72-4阳性	CA125阳性
T1	23	4(17.39)	4(17.39)	1(4.35)
T2	26	6(23.08)	7(26.92)	4(15.38)
T3	46	28(60.87)	31(67.39)	17(36.96)
T4a	9	6(66.67)	7(77.78)	7(77.78)
χ²值		18.471	23.396	21.380
P值		＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 6 联合诊断食管癌T分期与术后病理对照(例)

Table 6. Combined diagnosis of esophageal cancer T staging and postoperative pathological comparison (cases)

T分期	高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断T分期				合计
T分期	T1	T2	T3	T4a	合计
T1	22	1	0	0	23
T2	0	26	0	0	26
T3	0	2	44	0	46
T4a	0	0	2	7	9
合计	22	29	46	7	104

下载: 导出CSV

表 7 联合诊断食管癌T分期的诊断价值(%)

Table 7. Diagnostic value of T staging for combined diagnosis of esophageal cancer (%)

T分期	敏感度	特异度	准确率	阳性预测值	阴性预测值
T1	100.00	100.00	100.00	100.00	100.00
T2	100.00	96.15	97.11	89.65	100.00
T3	95.65	96.55	96.15	95.65	96.55
T4a	77.78	100.00	98.07	100.00	97.93

下载: 导出CSV

参考文献(20)

[1]	乔友林. 食管癌流行病学研究的重要里程碑[J]. 中国肿瘤临床, 2016, 43(12): 500-501. doi: 10.3969/j.issn.1000-8179.2016.12.551 QIAO Y L. An important milestone in the epidemiological study of esophageal cancer[J]. China Oncology Clinic, 2016, 43(12): 500-501. doi: 10.3969/j.issn.1000-8179.2016.12.551
[2]	艾迪叶·提力瓦力迪, 郑超, 穆艾太尔·麦提努日, 等. Nrf2和Keap1蛋白在食管鳞状细胞癌中的表达及意义[J]. 中华全科医学, 2019, 17(2): 176-178, 182. doi: 10.16766/j.cnki.issn.1674-4152.000632 AIDIYE · TiliWalidi, ZHENG C, MUAITAIER · Maitinuri, et al. Expression and significance of Nrf2 and Keap1 protein in esophageal squamous cell carcinoma[J]. Chinese Journal of General Practice, 2019, 17(2): 176-178, 182. doi: 10.16766/j.cnki.issn.1674-4152.000632
[3]	魏毅, 务森, 朱绍成, 等. 3.0TMR高分辨率成像对食管癌侵犯食管黏膜固有层至肌层肿瘤分期诊断的价值[J]. 中华放射学杂志, 2016, 50(11): 852-855. doi: 10.3760/cma.j.issn.1005-1201.2016.11.010 WEI Y, WU S, ZHU S C, et al. Evaluation of esophageal carcinoma in stage T1a, T1b and T2 with 3. 0 T high-resolution MR imaging[J]. Chinese Journal of Radiology, 2016, 50(11): 852-855. doi: 10.3760/cma.j.issn.1005-1201.2016.11.010
[4]	谢华英, 陈海燕, 张凤, 等. 功能磁共振成像与CT在食管癌T分期中的应用价值比较[J]. 上海交通大学学报(医学版), 2016, 36(7): 1029-1033. doi: 10.3969/j.issn.1674-8115.2016.07.014 XIE H Y, CHEN H Y, ZHANG F, et al. Comparison of the value of applying functional magnetic resonance imaging and CT imaging to T staging of esophageal cancer[J]. Journal of Shanghai Jiaotong University(Medical Science), 2016, 36(7): 1029-1033. doi: 10.3969/j.issn.1674-8115.2016.07.014
[5]	欧静, 陈天武, 唐隼, 等. 食管癌影像组学研究现状[J]. 国际医学放射学杂志, 2019, 42(4): 438-442. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC201904014.htm OU J, CHEN T W, TANG S, et al. Current status of radiomics in esophageal cancer[J]. International Journal of Medical Radiology, 2019, 42(4): 438-442. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC201904014.htm
[6]	吴丽明, 金鹿, 马继明, 等. 华蟾素胶囊、依托泊苷联合顺铂治疗老年非小细胞肺癌对患者炎症因子、血清肿瘤标志物的影响[J]. 海南医学, 2020, 31(1): 20-23. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202001006.htm WU L M, JIN L, MA J M, et al. Effect of Huachansu capsule plus etoposide combined with cisplatin on inflammatory factors and serum tumor markers in elderly patients with non-small-cell lung cancer[J]. Hainan Medical Journal, 2020, 31(1): 20-23. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202001006.htm
[7]	WANG Q, WU Y Y, ZHANG H, et al. Clinical value of serum HE4, CA125, CA72-4, and ROMA index for diagnosis of ovarian cancer and prediction of postoperative recurrence[J]. Clin lab, 2019, 65(4): 117-124.
[8]	HALTIA U M, HALLAMAA M, TAPPER J, et al. Roles of human epididymis protein 4, carbohydrate antigen 125, inhibin B and anti-Müllerian hormone in the differential diagnosis and follow-up of ovarian granulosa cell tumors[J]. Gynecol Oncol, 2017, 144(1): 83-89. doi: 10.1016/j.ygyno.2016.11.018
[9]	彭雄, 陈云, ABDILLANH N J, 等. 微创McKeown食管癌根治术与Ivor-Lewis手术治疗食管癌的近期疗效对比[J]. 中南大学学报(医学版), 2017, 42(5): 546-552. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201705011.htm PENG X, CHEN Y, ABDILLANH N J, et al. Comparison of short-term efficacy between minimally invasive McKeown radical resection for esophageal cancer and Ivor-Lewis surgery for esophageal cancer[J]. Journal of Central South University (Medical Edition), 2017, 42(5): 546-552. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD201705011.htm
[10]	陈梦雪, 桑楠, 葛献, 等. 表浅型食管癌经内镜黏膜下剥离术导致非治愈性切除的危险因素及长期生存分析[J]. 肿瘤防治研究, 2020, 47(4): 278-282. doi: 10.3971/j.issn.1000-8578.2020.19.0691 CHEN M X, SANG N, GE X, et al. Risk Factors of non-curative resection in superficial esophageal cancer after endoscopic submucosal dissection and long-term survival analysis[J]. Cancer Research on Prevention and Treatment, 2020, 47(4): 278-282. doi: 10.3971/j.issn.1000-8578.2020.19.0691
[11]	张志宏, 李良平, 刘晓岗, 等. 不同内镜方式判断早期食管癌浸润深度准确性的对比研究[J]. 中华消化内镜杂志, 2017, 34(1): 43-48. ZHANG Z H, LI L P, LIU X G, et al. Comparison of different endoscopic methods for infiltration depth of early esophageal cancer[J]. Chinese Journal of Digestive Endoscopy, 2017, 34(1): 43-48.
[12]	王金林, 陈倩, 吴小力, 等. 超声内镜在食管癌术前分期中的应用价值及存在的问题[J]. 世界华人消化杂志, 2017, 25(5): 438-442. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201705010.htm WANG J L, CHEN Q, WU X L, et al. Endoscopic ultrasound for preoperative staging of esophageal cancer: Application value and problems encountered[J]. World Chinese Journal of Digestology, 2017, 25(5): 438-442. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201705010.htm
[13]	GIGANTI F, AMBROSI A, PETRONE M C, et al. Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer: Results from a pilot study[J]. Br J Radiol, 2016, 89(1068): 87-94.
[14]	刘京京, 陈铟铟, 恽虹, 等. BLADE技术在自由呼吸导航CMR T₂WI中的应用价值[J]. 实用放射学杂志, 2018, 34(8): 1259-1262. LIU J J, CHEN Y Y, YUN H, et al. The value of BLADE technique applied in free-breathing respiratory navigated CMR T2-weighted imaging[J]. Journal of Practical Radiology志, 2018, 34(8): 1259-1262.
[15]	王建伟, 徐露露, 张玉东, 等. Star-VIBE和VIBE序列在食管MRI中的对照研究[J]. 实用放射学杂志, 2019, 35(10): 1668-1671. WANG J W, XU L L, ZHANG Y D, et al. Comparative study of StarGVIBE and VIBE sequences in MRI of esophagus[J]. Journal of Practical Radiology, 2019, 35(10): 1668-1671.
[16]	郭佳, 王昭琦, 张风光, 等. 高场强MRI与超声内镜对可切除性食管癌术前T分期应用价值的比较[J]. 中华放射学杂志, 2018, 52(3): 199-203. GUO J, WANG Z Q, ZHANG F G, et al. The value of 3 T MR in preoperative T staging of potentially resectable esophageal cancer compared withendoscopicultrasonography[J]. Chinese Journal of Radiology, 2018, 52(3): 199-203.
[17]	钱俊峰, 徐芳, 王洪源, 等. 血清CYFRA21-1、MMP-9及TTF-1水平在诊断肺恶性肿瘤患者中的临床价值[J]. 中华全科医学, 2019, 17(6): 951-954. doi: 10.16766/j.cnki.issn.1674-4152.000833 QIAN J F, XU F, WANG H Y, et al. Clinical value of CYFRA21-1, MMP-9 and TTF-1 levels in differentiating benign from malignant lung tumors[J]. Chinese Journal of General Practice, 2019, 17(6): 951-954. doi: 10.16766/j.cnki.issn.1674-4152.000833
[18]	杨宇明, 段贵新, 王安生. lncRNA HOTAIR及肿瘤标志物联合检测与肺癌病理分期的相关性研究[J]. 中华全科医学, 2020, 18(10): 1652-1655. doi: 10.16766/j.cnki.issn.1674-4152.001584 YANG Y M, DUAN G X, WANG A S. Correlation between lncRNA HOTAIR and tumor markers and pathological stage of lung cancer[J]. Chinese Journal of General Practice, 2020, 18(10): 1652-1655. doi: 10.16766/j.cnki.issn.1674-4152.001584
[19]	吴冬, 胡旭军, 林言. 不同血清肿瘤标志物对食管癌的诊断价值分析[J]. 中国卫生检验杂志, 2017, 27(4): 531-533. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201704024.htm WU D, HU X J, LIN Y. To evaluate the diagnostic value of different serum tumor markers for esophageal cancer[J]. Chinese Journal of Health Laboratory Technology, 2017, 27(4): 531-533. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201704024.htm
[20]	GAO Y F, WANG J P, ZHOU Y, et al. Evaluation of serum CEA, CA19-9, CA72-4, CA125 and ferritin as diagnostic markers and factors of cinical parameters for colorectal cancer[J]. Sci Rep, 2018, 8(1): 2732-2736.