【摘要】 目的 探讨MRI平扫、增强扫描以及弥散加权成像(DWI)检查后综合判读患者MRI-腹膜癌指数(PCI)、糖类抗原125(CA125)、人附睾蛋白4(HE4)以及罗马指数(ROMA指数)预测卵巢癌腹膜转移患者行肿瘤减灭术可行性的价值。方法 收集2018年2月至2022年10月宜昌市第二人民医院妇科住院治疗的晚期卵巢癌患者60例。所有患者均在术前2周内完成MRI平扫、增强扫描以及DWI成像检查,并进行MRI-PCI评分;术前1周内采集清晨空腹静脉血测定CA125、HE4,通过HE4值计算ROMA指数。所有患者均行肿瘤减灭术,依据肿瘤残存程度分为完全减灭组和不完全减灭组。采用Spearman秩相关分析MRI-PCI与术中PCI的相关性。ROC曲线分析MRI-PCI、CA125、HE4、ROMA指数预测不完全减灭术可行性的效能。结果 MRI-PCI与术中PCI呈正相关(r=0.871,P<0.001)。完全减灭组为18例,不完全减灭组为42例。完全减灭组MRIPCI评分和术中PCI评分均更低。在预测不完全减灭术可行性方面,MRI-PCI、CA125、HE4、ROMA指数的AUC分别为0.913、0.731、0.611、0.716。根据最大约登指数计算MRI-PCI最佳截断值为4.5分时,预测不完全减灭术的灵敏度为0.920,特异度为0.898,阳性预测值为0.781,阴性预测值为0.822;CA125最佳截断值为880.26 U/mL时,预测不完全减灭术的灵敏度为0.780,特异度为0.655,阳性预测值为0.711,阴性预测值为0.733;HE4最佳截断值为488.98 pmol/L,预测不完全减灭术的灵敏度为0.760,特异度为0.780,阳性预测值为0.611,阴性预测值为0.717;ROMA指数最佳截断值为96.53%时,预测不完全减灭术的灵敏度为0.688,特异度为0.898,阳性预测值为0.647,阴性预测值为0.802。结论 MRI-PCI与术中PCI呈正相关,当MRI-PCI为4.5分时预测不完全减灭术可行性最有价值。更多还原

【Abstract】 Objective To investigate the value of MRI peritoneal cancer index(MRI-PCI), carbohydrate antigen 125(CA125), human epididymis protein 4(HE4), and Roman index(ROMA index) in predicting efficacy of tumor reductive surgery for patients with ovarian cancer peritone is metastasis. Methods Sixty patients with advanced ovarian cancer admitted in Yichang Second People’s Hospital from February 2018 to October 2022 were enrolled. All patients completed MRI plain scan, contrast-enhanced scan, and DWI imaging within 2 weeks prior to surgery, and MRI-PCI score was calculated.Serum CA125 and HE4 levels were measured within one week before surgery. All patients underwent tumor reduction surgery and were divided into complete reduction group and incomplete reduction group. Pearson correlation analysis was used to examine the correlation between preoperative MRI-PCI and intraoperative PCI. ROC curve was used to analyze the value of MRI-PCI, CA125, HE4, and ROMA index in predicting surgical efficacy. Results Spearman correlation coefficient between preoperative MRI-PCI and intraoperative PCI was 0.898. In predicting incomplete reduction surgery,the AUC of MRI-PCI, CA125, HE4, and ROMA curves were 0.913, 0.731, 0.611 and 0.716 respectively. The optimal cut-off value of MRI-PCI was 4.5, and the sensitivity, specificity, positive predictive value and negative predictive value for predicting incomplete reductive surgery were 0.920, 0.898, 0.781 and 0.822, respectively. The optimal cut-off values of CA125, HE4 and ROMA index were 880.26 U/mL, 488.98 pmol/L and 96.53%, respectively; the corresponding sensitivity was 0.782, 0.760 and 0.688; the specificity was 0.655, 0.780 and 0.898; the positive predictive value was 0.711, 0.611 and 0.647;the negative predictive value was 0.733, 0.717 and 0.802, respectively. Conclusion MRI-PCI is significantly correlated with intraoperative PCI, and it has the best predictive value for incomplete reduction surgery when MRI-PCI is 4.5.更多还原