MRI联合术前血清学指标及病理特征对早期宫颈癌淋巴结转移的预测价值

赵梦秋; 晋茂生; 刘红丽; 刘健

doi:10.16766/j.cnki.issn.1674-4152.002844

MRI联合术前血清学指标及病理特征对早期宫颈癌淋巴结转移的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002844

1.
蚌埠医学院第一附属医院妇产科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院肿瘤妇科

基金项目:

安徽省高校自然科学重点项目 KJ2019A0346

详细信息

通讯作者:
晋茂生，E-mail：676926817@qq.com

中图分类号: R737.33 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2022-05-17
- 网络出版日期: 2023-04-20

Prediction of lymph node metastasis in early cervical cancer by MRI combined with preoperative serological indices and pathological features

1.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨MRI与术前血清学指标鳞状细胞癌抗原(SCC-Ag)、中性粒细胞与淋巴细胞比值(NLR)及活检病理联合对早期宫颈癌淋巴结转移(LNM)的预测价值。方法选取2019年1月—2022年2月在蚌埠医学院第一附属医院行初次手术的宫颈癌患者307例，按术后病理是否存在淋巴结转移分为淋巴结转移组81例和未转移组226例，比较2组患者的MRI淋巴结短径、肿瘤直径、间质浸润深度、宫旁浸润和阴道受累，术前血清学指标以及病理特征。分析联合诊断对淋巴结转移的预测价值。结果 Logistic回归分析显示MRI淋巴结短径大、MRI肿瘤直径大、MRI间质浸润深度>1/2肌层、MRI宫旁浸润、术前SCC-Ag水平升高和脉管浸润是宫颈癌淋巴结转移的独立危险因素(均P < 0.05)。MRI淋巴结短径、术前SCC-Ag水平、NLR诊断宫颈癌LNM的ROC曲线下面积分别为0.806、0.711、0.630，最佳截断值分别为8.50 mm、2.55 ng/mL、1.90，灵敏度分别为0.654、0.593、0.593，特异度分别为0.881、0.757、0.642；MRI淋巴结短径联合SCC-Ag诊断的ROC曲线下面积为0.846；MRI淋巴结短径、术前SCC-Ag水平、NLR三者联合诊断的ROC曲线下面积为0.863。多指标(术前SCC-Ag水平、MRI淋巴结短径、肿瘤直径、间质浸润深度、宫旁浸润以及脉管浸润)联合诊断宫颈癌LNM的ROC曲线下面积为0.926。结论影像学检查与血清学指标和临床病理特征联合可以提高对宫颈癌淋巴结转移的预测价值。
- 宫颈癌 /
- 淋巴结转移 /
- 磁共振成像 /
- 鳞状细胞癌抗原 /
- 中性粒细胞与淋巴细胞比值
Abstract: Objective This study aims to investigate the predictive value of MRI combined with preoperative serological markers: squamous cell carcinoma antigen (SCC-Ag), neutrophil to lymphocyte ratio (NLR) and biopsy pathology in lymph node metastasis of early cervical cancer. Methods A total of 307 patients who underwent primary surgery in the First Affiliated Hospital of Bengbu Medical College from January 2019 to February 2022 were selected and divided into lymph node metastasis group (81 cases) and no lymph node metastasis group (226 cases) according to the presence or absence of lymph node metastasis after surgery. The MRI lymph node short diameter, tumour size, interstitial infiltration depth, parauterine and vaginal involvement, preoperative serological indices and pathological features of the 2 groups were compared. The predictive value of lymph node metastasis and the significance of combined diagnosis were analysed. Results Logistic regression analysis showed that large short diameter of MRI lymph nodes, large tumor diameter, depth of interstitial infiltration greater than 1/2 muscular layer, parametrial involvement, increased expression of SCC-Ag and positive vascular were independent risk factors for lymph node metastasis of cervical cancer (P < 0.05). The areas under the ROC curve of MRI lymph node diameter, SCC-Ag and NLR for the diagnosis of cervical cancer LNM were 0.806, 0.711 and 0.630, respectively. The optimal cut-off values were 8.50 mm, 2.55 ng/mL and 1.90, respectively. The sensitivity values were 0.654, 0.593 and 0.593, respectively, and the specificity values were 0.881, 0.757 and 0.642, respectively. The area under the ROC curve of MRI lymph node short diameter combined with SCC-Ag diagnosis was 0.846. The area under ROC curve for the combined diagnosis of MRI lymph node short diameter, SCC-Ag and NLR was 0.863. The area under ROC curve of multiple indicators (SCC-Ag, MRI lymph node short diameter, tumour size, interstitial infiltration depth, parauterine involvement, and vascular positive) for combined diagnosis of cervical cancer LNM was 0.926. Conclusion Imaging examination (MRI) combined with serological indicators and clinicopathological features can improve the predictive value of cervical cancer lymph node metastasis.
- Cervical cancer /
- Lymph node metastasis /
- Magnetic resonance imaging /
- Squamous cell carcinoma antigen /
- Neutrophil-lymphocyte ratio

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图 1 不同指标诊断宫颈癌淋巴结转移的ROC曲线

注: 多指标包含MRI淋巴结短径、肿瘤直径、宫旁浸润、间质浸润深度、SCC-Ag、脉管浸润。

Figure 1. ROC curve of cervical cancer lymph node metastasis diagnosed by different indexes

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表 1 影响淋巴结转移的单因素分析

Table 1. Univariate analysis of influence on factors affecting lymph node metastasis

项目	转移组(81例)	未转移组(226例)	统计量	P值
年龄(x±s，岁)	49.98±7.84	52.19±9.82	1.827^a	0.069
分娩次数[M(P₂₅, P₇₅)，次]	2(2, 3)	2(2, 3)	-1.153^b	0.249
病程[M(P₂₅, P₇₅)，月]	3(1, 6)	3(1, 6)	-0.335^b	0.737
NLR[M(P₂₅, P₇₅)]	1.96(1.47, 2.72)	1.67(1.31, 2.10)	-3.479^b	＜0.001
MRI肿瘤直径[M(P₂₅, P₇₅), cm]	4.36(3.50, 5.15)	3.00(2.00, 3.60)	-7.510^b	＜0.001
MRI淋巴结短径[M(P₂₅, P₇₅), mm]	9.80(7.35, 11.35)	6.50(5.80, 7.30)	-8.182^b	＜0.001
术前SCC-Ag水平[M(P₂₅, P₇₅), ng/mL]	3.20(1.98, 5.45)	1.80(1.10, 2.50)	-5.638^b	＜0.001
肿瘤类型[例(%)]			0.069^c	0.793
内生型	60(74.1)	164(72.6)
外生型	21(25.9)	62(27.4)
MRI宫旁浸润[例(%)]			66.061^c	＜0.001
是	35(43.2)	12(5.3)
否	46(56.8)	214(94.7)
MRI阴道受累[例(%)]			24.380^c	＜0.001
是	52(64.2)	74(32.7)
否	29(35.8)	152(67.3)
脉管浸润[例(%)]			67.721^c	＜0.001
是	38(46.9)	15(6.6)
否	43(53.1)	211(93.4)
MRI间质浸润深度[例(%)]			33.760^c	＜0.001
< 1/2肌层	10(12.3)	111(49.1)
≥1/2肌层	71(87.7)	115(50.9)
临床分期[例(%)]			24.970^c	＜0.001
ⅠA	1(1.2)	17(7.5)
ⅠB	33(40.7)	146(64.6)
ⅡA	47(58.0)	63(27.9)
肿瘤细胞分化程度[例(%)]			5.545^c	0.062
Ⅰ	1(1.2)	18(8.0)
Ⅱ	48(59.3)	137(60.6)
Ⅲ	32(39.5)	71(31.4)
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 影响淋巴结转移的多因素分析

Table 2. Analysis of multiple factors affecting lymph node metastasis

变量	B	SE	Wald χ²	P值	OR(95% CI)
NLR	0.369	0.230	2.586	0.108	1.446(0.922~2.268)
MRI肿瘤直径	0.412	0.176	5.497	0.019	1.510(1.070~2.131)
术前SCC-Ag水平	0.117	0.059	3.892	0.049	1.124(1.001~1.263)
MRI宫旁浸润	1.067	0.529	4.076	0.044	2.908(1.032~8.195)
MRI阴道受累	0.000	0.441	0.000	0.999	1.000(0.421~2.375)
MRI间质浸润深度	1.102	0.514	4.602	0.032	3.010(1.100~8.236)
临床分期	0.001	0.406	0.000	0.998	1.001(0.452~2.219)
MRI淋巴结短径	0.486	0.088	30.340	＜0.001	1.626(1.367~1.932)
脉管浸润	1.988	0.465	18.301	＜0.001	7.298(2.936~18.142)
注：变量赋值如下, NLR、MRI肿瘤直径、SCC-Ag、MRI淋巴结短径以实际值进行赋值; MRI提示可疑宫旁浸润=1，MRI未提示可疑宫旁浸润=0；MRI提示阴道受累=1，MRI未提示阴道受累=0；MRI间质浸润深度 < 1/2肌层=0, MRI间质浸润深度>1/2肌层=1；临床分期ⅠA=0，ⅠB=1，ⅡA=2；有脉管浸润=1，无脉管浸润=0。

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表 3 各指标的敏感度、特异度、阳性预测值、阴性预测值

Table 3. Sensitivity, specificity, positive predictive value and negative predictive value of each index

指标	灵敏度	特异度	阳性预测值(%)	阴性预测值(%)	95% CI
MRI淋巴结短径	0.654	0.881	66.3	87.7	0.744~0.868
术前SCC-Ag水平	0.593	0.757	46.6	83.8	0.644~0.778
NLR	0.593	0.642	37.2	81.5	0.556~0.705
MRI淋巴结短径联合SCC-Ag	0.765	0.823	60.8	90.7	0.794~0.898
MRI淋巴结短径、SCC-Ag联合NLR	0.778	0.850	64.3	91.4	0.814~0.912
多指标联合	0.877	0.872	71.0	95.2	0.893~0.960

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