CAJ | 학술논문

目的探讨超声双重造影(double contrast-enhanced ultrasono-graphy,DCUS)在进展期胃癌新辅助化疗后T分期及疗效评价中的价值.方法回顾性分析29例进展期胃癌患者,化疗前经DCUS评估为T3、T4期,给予2～4个疗程的新辅助化疗,然后再行DCUS进行T分期,并与术后病理结果相比较,根据新实体瘤疗效评价标准(RECIST)将新辅助化疗患者分为两组:化疗获益组(22例,包括完全缓解0例,部分缓解14例及稳定期8例)及化疗进展组(7例),同时运用ACQ脱机软件获取病灶的造影参数,采用重复测量数据的方差分析评价不同疗效及化疗前后间造影各参数的变化.结果超声双重造影对胃癌新辅助化疗后T分期总准确率达65.52％,T2、T3、T4的准确率分别为0％、42.86％、92.86％,比较超声双重造影T分期与术后病理T分期的一致性,Kappa值=0.33；新辅助化疗后获益组增强强度(EI)值、峰值强度(PI)值下降,而进展组不降反略升,获益组与进展组间基础强度值(BI)的主效应差异无统计学意义(P＞0.05).结论 DCUS对于新辅助化疗后的进展期胃癌患者T分期准确率不高.新辅助化疗后获益组EI值、PI值下降较进展组明显,有望作为评价新辅助化疗疗效的重要参考指标.
목적 탐토초성쌍중조영(double contrast-enhanced ultrasono-graphy,DCUS)재진전기위암신보조화료후T분기급료효평개중적개치.방법 회고성분석29례진전기위암환자,화료전경DCUS평고위T3、T4기,급여2～4개료정적신보조화료,연후재행DCUS진행T분기,병여술후병리결과상비교,근거신실체류료효평개표준(RECIST)장신보조화료환자분위량조:화료획익조(22례,포괄완전완해0례,부분완해14례급은정기8례)급화료진전조(7례),동시운용ACQ탈궤연건획취병조적조영삼수,채용중복측량수거적방차분석평개불동료효급화료전후간조영각삼수적변화.결과 초성쌍중조영대위암신보조화료후T분기총준학솔체65.52％,T2、T3、T4적준학솔분별위0％、42.86％、92.86％,비교초성쌍중조영T분기여술후병리T분기적일치성,Kappa치=0.33；신보조화료후획익조증강강도(EI)치、봉치강도(PI)치하강,이진전조불강반략승,획익조여진전조간기출강도치(BI)적주효응차이무통계학의의(P＞0.05).결론 DCUS대우신보조화료후적진전기위암환자T분기준학솔불고.신보조화료후획익조EI치、PI치하강교진전조명현,유망작위평개신보조화료료효적중요삼고지표.
Objective To determine staging accuracy of double contrast-enhanced ultrasonography (DCUS)after neoadjuvant chemotherapy,and to evaluate effect during neoadjuvant chemotherapy for advanced gastric carcinoma(AGC).Methods A total of 29 patients with AGC diagnosed by endoscopy were examined and staged using ultrasound after taking oral contrast agent and bolus injection of SonoVue (DCUS)pre-and post-neoadjuvant chemotherapy.T-stage accuracy of post-neoadjuvant chemotherapy and pathological T status of postoperative were compared.All of the subjects were divided into two groups according to RECIST(Response Evaluation Criteria in Solid Tumors):chemotherapy benefit group(22cases,including:complete response 0 cases.partial response 14 cases,stable disease 8 cases)and progressive group(7 cases).The findings of DCUS of AGC tissues were assessed by auto-tracking contrast quantification(ACQ)software.The baseline intensity(BI)and peak intensity(PI)of gastric carcinoma tissues were measured automatically,and the enhanced intensity(EI)of gastric carcinoma tissues was calculated manually(EI =PI-BI).The quantitative analysis findings of DCUS of each patient pre-and postneoadjuvant chemotherapy between two groups were compared adopting repeated measures method.Results The overall accuracy of T staging in AGC patients after neoadjuvant chemotherapy were 65.52％ by DCUS,and 0,42.86％and 92.86％respectively for T2 stage,T3 stage and T4 stage.The agreement of this method was weak between T-stage accuracy post-neoadjuvant chemotherapy and pathological T status of postoperative.The Kappa value was 0.33.The difference value of PI and EI between pre-and postneoadjuvant chemotherapy in AGC patients for benefit group was more than that in progressive group.The main effect of BI in AGC tissues between pre-and post-neoadjuvant chemotherapy was no significant difference between two groups(P＞0.05).Conclusions Restaging by DCUS after neoadjuvant chemotherapy in AGC patients was found to be inaccurate.However,the difference value of PI and EI between pre-and post-neoadjuvant chemotherapy in AGC tissues for benefit group was more than that in progressive group.Thus,the value of PI and EI by ICUS may be a useful clinical parameter with which to evaluate the effect during neoadjuvant chemotherapy and guide therapeutic regimen for AGC patients.