CAJ | 학술논문

目的：探讨磁共振弥散加权成像对新辅助化疗后宫颈癌患者无进展生存期（ Progression free survival ，PFS）的预测作用。方法回顾性分析经术后病理证实为宫颈癌的患者32例，分析术后病理、治疗前及化疗后常规MRI 及DWI 检查结果，用Kaplan－Meier和Cox风险比例回归对所有患者病理结果及MRI资料进行单因素及多因素生存期分析。 ROC曲线用于寻找独立预后因素预测疾病进展的临界值。结果32例患者中10例在随访期出现疾病进展。平均随访时间31．6±6．3个月。单因素分析结果显示FIGO分期、肿瘤最大径线、肌层浸润深度、淋巴结转移及治疗前后ADC值变化（ ADC change be-tween before and after neoadjuvant chemotherapy ，ΔADC）值与疾病进展有关。多因素分析显示FIGO分期与ΔADC为患者无进展生存期的独立预后因素，ROC曲线获得的临界值分别为2．00和0．31，曲线下面积分别为0．841（敏感度90．0％，特异度68．2％）和0．864（敏感度80．0％，特异度81．8％）。结论在新辅助治疗的宫颈癌患者中，FIGO分期和ΔADC值对无进展生期有一定预测作用。
목적：탐토자공진미산가권성상대신보조화료후궁경암환자무진전생존기（ Progression free survival ，PFS）적예측작용。방법회고성분석경술후병리증실위궁경암적환자32례，분석술후병리、치료전급화료후상규MRI 급DWI 검사결과，용Kaplan－Meier화Cox풍험비례회귀대소유환자병리결과급MRI자료진행단인소급다인소생존기분석。 ROC곡선용우심조독립예후인소예측질병진전적림계치。결과32례환자중10례재수방기출현질병진전。평균수방시간31．6±6．3개월。단인소분석결과현시FIGO분기、종류최대경선、기층침윤심도、림파결전이급치료전후ADC치변화（ ADC change be-tween before and after neoadjuvant chemotherapy ，ΔADC）치여질병진전유관。다인소분석현시FIGO분기여ΔADC위환자무진전생존기적독립예후인소，ROC곡선획득적림계치분별위2．00화0．31，곡선하면적분별위0．841（민감도90．0％，특이도68．2％）화0．864（민감도80．0％，특이도81．8％）。결론재신보조치료적궁경암환자중，FIGO분기화ΔADC치대무진전생기유일정예측작용。
Objective To evaluate the predictive value of diffusion weighted imaging ( DWI) for progres-sion free survival(PFS)in patients with cervix cancer after neoadjuvant chemotherapy (NACT).Methods Thirty two consecutive patients with pathologically confirmed cervical cancer underwent MRI including DWI before and after NACT.Pathologic results and MR images were reviewed .Univariate analysis was applied by Kaplan -Meier method.The Cox proportional hazard model was used to evaluate prognostic variables for multivariate analysis .Re-ceiver operating characteristic ( ROC) curves were used to find optimal cutoff values of independent prognostic fac -tors for disease progression.Results Of 32 patients,10 had disease progression during follow -up period.In uni-variate analysis,FIGO stage,tumor size,the depth of tumor invasion,lymph node metastasis and ADC changes be-tween before and after neoadjuvant chemotherapy (ΔADC) were significantly associated with the disease progres-sion.In multivariate analysis , FIGO stage and ΔADC were the independent prognostic factors for PFS .Optimal cutoff values that determined by ROC curves analyses were FIGO stage ⅡandΔADC 0.31.Area under the ROC curve(AUC)of FIGO stage and ΔADC were 0.841(sensitivity 90.0%,specificity 68.2%)and 0.864(sensitivity 80.0%,specificity 81.8%),respectively.Conclusion In patients with cervix cancer after NACT ,FIGO stage andΔADC are significant predictive values for PFS .