双能CT对胃间质瘤中Ki-67表达的预测价值及其与病理参数的关系

doi:10.3969/j.issn.1004-583X.2021.11.011

摘要/Abstract

摘要：

目的探讨双能CT对胃间质瘤中Ki-67表达的预测价值及其与病理参数的关系。方法回顾性选取2019年2月至2020年4月期间收治胃间质瘤患者82例,进行双能CT检查、Ki-67表达测定,根据Ki-67表达指数分为两组,即39例高表达组(Ki-67表达>6%)、43例低表达组(Ki-67表达≤6%),分析两组临床病理特征,对比不同Ki-67表达下CT间各参数值,用ROC曲线分析CT间各参数值对Ki-67表达含量的预测价值,同时用Pearson法分析Ki-67指数与临床病理参数相关性。结果高表达组动脉期和静脉期的40 ke V CT值、50 ke V CT值、60 ke V CT值、70 ke V CT值、IC值、NIC值均高于低表达组(P<0.05)。ROC曲线分析表明,静脉期40 ke V CT值、50 ke V CT值、60 ke V CT值、70 ke V CT值、IC值、NIC值鉴别Ki-67表达含量的AUC依次为0.867、0.907、0.939、0.758、0.952、0.854;动脉期各参数鉴别Ki-67表达含量的AUC依次为0.998、0.944、0.967、0.888、0.925、0.764。经Pearson法分析,Ki-67指数与各参数均呈负相关,与单发/多发、核分裂象、有无出血、肿瘤部位呈负相关,与危险度分级呈正相关。结论双能CT动静脉期的40、50、60、70CT值以及IC值、NIC值与Ki-67指数呈负相关,可反映胃间质瘤细胞增殖程度,同时Ki-67表达可作为评估胃间质瘤预后、危险度分级的重要参考指标。

关键词: 双能CT, 胃间质瘤, Ki-67, 预测, 病理参数

Abstract:

Objective To explore the predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors(GST) and its relationship with pathological factors. Methods Totally 82 GST patients admitted from February 2019 and April 2020 were retrospectively selected. Dual-energy CT were performed to measure Ki-67, the patients were divided into two groups based on Ki-67 expression, namely 39 cases in high expression group (Ki-67>6%), 43 cases in low expression group (Ki-67≤6%). Pathological factors were analyzed in between groups, and CT parameters were compared between Ki-67 different expressions. Receiver operating characteristic(ROC) curve analysis were used to analyze the predictive value of CT parameters, the correlation between Ki-67 index expression and pathological factors by Pearson's correlation coefficient. Results The values of each phase (40 keV, 50 keV, 60 keV, 70 keV) and iodine concentration(IC), normalized iodine concentration(NIC) on arterial and venous phase were higher in high expression group than in concurrent low expression group (P<0.05). The area under curve(AUC) of the parameters to identify Ki-67 expression on venous phase were 0.867, 0.907, 0.939, 0.758, 0.952 and 0.854, respectively, and with 0.998, 0.944, 0.967, 0.888, 0.925 and 0.764 on arterial phase, respectively. Pearson's correlation analysis showed Ki-67 expression were negatively correlated with the parameters. Meanwhile the indexes negatively correlated with single/multiple, nuclear division, with or without bleeding, tumor location. A positively correlated was found between Ki-67 expression and the risk classification.Conclusion Dual-energy CT value of each phase (40 keV, 50 keV, 60 keV, 70 keV), and IC value, NIC value on arterial and venous phase are negatively correlated with Ki-67 expression, which may reflect GST cell proliferation, moreover Ki-67 expression can use to be an important reference index for prognosis and risk grading of GST.

Key words: dual-energy CT, gastric stromal tumor, Ki-67, prediction, pathological parameters

中图分类号:

R735.2

原士超, 赵庆, 范红燕. 双能CT对胃间质瘤中Ki-67表达的预测价值及其与病理参数的关系[J]. 临床荟萃, 2021, 36(11): 1013-1018.

Yuan Shichao, Zhao Qing, Fan Hongyan. Predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors and relationship with pathological factors[J]. Clinical Focus, 2021, 36(11): 1013-1018.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.11.011

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I11/1013

图/表 8

参考文献 16

[1]	马卫霞, 于春梅, 孙明霞. 胃肠道间质瘤的CT和MRI特征及其与病理危险度的关系[J]. 癌症进展, 2019, 17(8):942-944, 978.
[2]	王泽涛, 陈剑通, 尚国印. Ki67免疫组化染色指数与胃间质瘤临床病理特征及预后的关系[J]. 哈尔滨医科大学学报, 2019, 53(5):513-516.
[3]	Sahin S, Ekinci O, Seckin S, et al. Proliferation markers RacGAP1 and Ki-67 in gastrointestinal stromal tumors by immunohistochemistry with respect to clinicopathological features and different risk stratification systems[J]. Int J Clin Exp Pathol, 2017, 10(12):11723-11736.
[4]	宋学林, 刘玉霞, 杨世锋, 等. 胃肠道间质瘤的MSCT征象与临床病理的对照研究[J]. 医学影像学杂志, 2020, 30(8):1412-1417.
[5]	汪明, 曹晖. NCCN《软组织肉瘤临床实践指南(2017年第2版)》胃肠间质瘤内容介绍与更新解读[J]. 中国实用外科杂志, 2017, 37(6):644-648.
[6]	赵宇, 刘辉, 习羽, 等. 胃间质瘤CT征象与肿瘤危险度分级的关系[J]. 实用放射学杂志, 2016, 32(6):892-895.
[7]	Pyo JS, Kang G, Sohn JH. Ki-67 labeling index can be used as a prognostic marker in gastrointestinal stromal tumor: A systematic review and meta-analysis[J]. Int J Biol Markers, 2016, 31(2):204-210. doi: 10.5301/jbm.5000183 URL
[8]	王帆荣, 陈芸, 李梅, 等. 胃肠道间质瘤中Ki-67表达及其与临床病理特征、危险度分级的相关性[J]. 临床与实验病理学杂志, 2017, 33(9):1022-1025.
[9]	Pih GY, Jeon SJ, Ahn JY, et al. Clinical outcomes of upper gastrointestinal bleeding in patients with gastric gastrointestinal stromal tumor[J]. Surg Endosc, 2020, 34(2):696-706. doi: 10.1007/s00464-019-06816-9 URL
[10]	孟建民, 陈立光. 基于增强CT的胃肠道间质瘤纹理分析对术前危险度分级的预测价值[J]. 医学影像学杂志, 2019, 29(3):420-424.
[11]	吕悦, 刘爱连, 刘静红, 等. 能谱单能量图像影像组学在胃癌分级中的应用[J]. 中国医学计算机成像杂志, 2018, 24(5):421-425.
[12]	唐雪松, 周宇. 基于增强CT的胃肠道间质瘤纹理分析对术前危险度分级的预测价值[J]. 新疆医科大学学报, 2019, 42(1):91-95.
[13]	朱从波, 廖国庆, 赵丁民. Ki-67对胃肠道间质瘤预后的评估价值[J]. 临床与病理杂志, 2018, 38(8):48-55.
[14]	Kalfusova A, Hilska I, Krskova L, et al. Gastrointestinal stromal tumors-quantitative detection of the Ki-67, TPX2, TOP2A, and hTERT telomerase subunit mRNA levels to determine proliferation activity and a potential for aggressive biological behavior[J]. Neoplasma, 2016, 63(3):484-492. doi: 10.4149/320_150714N390 pmid: 26952515
[15]	郭迎雪, 贾建宾, 聂双发, 等. 胃肠道间质瘤主要免疫表型及其与危险度分级和预后的关系[J]. 中国医药导报, 2018, 15(29):110-113.
[16]	芦淑娟, 关佳楠. 胃肠间质瘤组织中Ki-67、COX-2、VEGF表达的意义[J]. 热带医学杂志, 2017, 17(4):483-486.

项目	高表达组(n=39)	低表达组(n=43)	t值	P值
动脉期
40 ke V CT值(HU)	172.25±13.65	116.38±12.33	19.475	<0.01
50 ke V CT值(HU)	125.49±21.74	85.54±10.19	10.816	<0.01
60 ke V CT值(HU)	93.31±12.27	64.28±10.10	11.739	<0.01
70 ke V CT值(HU)	74.59±13.35	52.47±12.24	7.828	<0.01
IC值(×10²μg/cm³)	15.25±2.68	10.16±2.37	9.127	<0.01
NIC值	0.18±0.09	0.10±0.02	5.680	<0.01
静脉期
40 ke V CT值(HU)	180.46±21.63	141.12±29.68	6.799	<0.01
50 ke V CT值(HU)	128.53±16.39	100.25±15.51	8.026	<0.01
60 ke V CT值(HU)	95.74±12.45	74.68±10.17	8.421	<0.01
70 ke V CT值(HU)	73.69±15.39	60.25±10.28	4.689	<0.01
IC值(×10²μg/cm³)	18.96±2.35	13.44±1.24	13.478	<0.01
NIC值	0.37±0.10	0.25±0.04	7.258	<0.01
平衡期
40 ke V CT值(HU)	181.35±35.46	179.85±33.35	0.197	0.844
50 ke V CT值(HU)	127.49±30.46	125.48±32.56	0.288	0.774
60 ke V CT值(HU)	92.46±15.33	90.46±17.19	0.554	0.581
70 ke V CT值(HU)	72.79±12.36	70.59±10.44	0.873	0.385
IC值(×10²μg/cm³)	18.43±2.16	17.49±3.22	1.536	0.128
NIC值	0.52±0.05	0.54±0.07	1.475	0.144

项目	高表达组(n=39)	低表达组(n=43)	t值	P值
动脉期
40 ke V CT值(HU)	172.25±13.65	116.38±12.33	19.475	<0.01
50 ke V CT值(HU)	125.49±21.74	85.54±10.19	10.816	<0.01
60 ke V CT值(HU)	93.31±12.27	64.28±10.10	11.739	<0.01
70 ke V CT值(HU)	74.59±13.35	52.47±12.24	7.828	<0.01
IC值(×10²μg/cm³)	15.25±2.68	10.16±2.37	9.127	<0.01
NIC值	0.18±0.09	0.10±0.02	5.680	<0.01
静脉期
40 ke V CT值(HU)	180.46±21.63	141.12±29.68	6.799	<0.01
50 ke V CT值(HU)	128.53±16.39	100.25±15.51	8.026	<0.01
60 ke V CT值(HU)	95.74±12.45	74.68±10.17	8.421	<0.01
70 ke V CT值(HU)	73.69±15.39	60.25±10.28	4.689	<0.01
IC值(×10²μg/cm³)	18.96±2.35	13.44±1.24	13.478	<0.01
NIC值	0.37±0.10	0.25±0.04	7.258	<0.01
平衡期
40 ke V CT值(HU)	181.35±35.46	179.85±33.35	0.197	0.844
50 ke V CT值(HU)	127.49±30.46	125.48±32.56	0.288	0.774
60 ke V CT值(HU)	92.46±15.33	90.46±17.19	0.554	0.581
70 ke V CT值(HU)	72.79±12.36	70.59±10.44	0.873	0.385
IC值(×10²μg/cm³)	18.43±2.16	17.49±3.22	1.536	0.128
NIC值	0.52±0.05	0.54±0.07	1.475	0.144

项目	AUC	标准误	P值	95%CI		敏感度	特异度	约登指数	Cut-off值
项目	AUC	标准误	P值	下限	上限	敏感度	特异度	约登指数	Cut-off值
动脉期
40 ke V CT值	0.998	0.002	0.000	0.994	1.000	97.4	100.0	0.974	144.875
50 ke V CT值	0.944	0.029	0.000	0.887	1.000	89.7	93.0	0.827	99.410
60 ke V CT值	0.967	0.017	0.000	0.933	1.000	94.9	90.7	0.856	78.135
70 ke V CT值	0.888	0.035	0.000	0.821	0.956	74.4	88.4	0.628	65.265
IC值	0.925	0.028	0.000	0.869	0.981	89.7	86.0	0.757	12.385
NIC值	0.764	0.061	0.000	0.644	0.884	66.7	100.0	0.667	0.135
静脉期
40 ke V CT值	0.867	0.040	0.000	0.789	0.945	84.6	81.4	0.660	166.32
50 ke V CT值	0.907	0.033	0.000	0.843	0.971	89.7	81.4	0.711	113.385
60 ke V CT值	0.939	0.027	0.000	0.885	0.992	97.4	86.0	0.834	83.820
70 ke V CT值	0.758	0.054	0.000	0.652	0.863	51.3	90.7	0.420	72.080
IC值	0.952	0.027	0.000	0.899	1.000	89.7	100.0	0.897	16.375
NIC值	0.854	0.041	0.000	0.774	0.935	69.2	83.7	0.529	0.285

项目	AUC	标准误	P值	95%CI		敏感度	特异度	约登指数	Cut-off值
项目	AUC	标准误	P值	下限	上限	敏感度	特异度	约登指数	Cut-off值
动脉期
40 ke V CT值	0.998	0.002	0.000	0.994	1.000	97.4	100.0	0.974	144.875
50 ke V CT值	0.944	0.029	0.000	0.887	1.000	89.7	93.0	0.827	99.410
60 ke V CT值	0.967	0.017	0.000	0.933	1.000	94.9	90.7	0.856	78.135
70 ke V CT值	0.888	0.035	0.000	0.821	0.956	74.4	88.4	0.628	65.265
IC值	0.925	0.028	0.000	0.869	0.981	89.7	86.0	0.757	12.385
NIC值	0.764	0.061	0.000	0.644	0.884	66.7	100.0	0.667	0.135
静脉期
40 ke V CT值	0.867	0.040	0.000	0.789	0.945	84.6	81.4	0.660	166.32
50 ke V CT值	0.907	0.033	0.000	0.843	0.971	89.7	81.4	0.711	113.385
60 ke V CT值	0.939	0.027	0.000	0.885	0.992	97.4	86.0	0.834	83.820
70 ke V CT值	0.758	0.054	0.000	0.652	0.863	51.3	90.7	0.420	72.080
IC值	0.952	0.027	0.000	0.899	1.000	89.7	100.0	0.897	16.375
NIC值	0.854	0.041	0.000	0.774	0.935	69.2	83.7	0.529	0.285

项目	Ki-67指数
项目	r值	P值
40 ke V CT值	-0.909	0.000
50 ke V CT值	-0.771	0.000
60 ke V CT值	-0.795	0.000
70 ke V CT值	-0.659	0.000
IC值	-0.714	0.000
NIC值	-0.539	0.000