【作者】 李伟；

【导师】 张胜；

【作者基本信息】 中南大学 ， 口腔医学（专业学位）， 2024， 硕士

【摘要】 目的:探讨基于MRI测量的舌鳞状细胞癌(Tongue squamous cell carcinoma,TSCC)的肿瘤体积、表面积、浸润深度以及在MRI上的肿瘤形态学特征与Ki-67增殖指数的关系,并进一步探讨它们与患者预后的关系。方法:选取2021年01月至2023年07月在中南大学湘雅二医院口腔颌面外科病房出院诊断为TSCC的患者76例,进行回顾性研究,收集患者临床资料、MRI影像学资料和生存资料,MRI影像导入3D-Slicer软件中测量肿瘤体积、表面积及浸润深度,在增强图像上观察并记录肿瘤的形态学特征,包括肿瘤内和肿瘤边缘强化模式,分析MR影像学参数与Ki-67增殖指数的关系。对患者进行随访,分析MR影像学参数及Ki-67增殖指数与预后的相关性。结果:76例患者的Ki-67增殖指数在5至90之间,中位数为42.5。经3D-Slicer软件测量所得的肿瘤体积在334.47mm~3至56454.2mm~3范围内,平均肿瘤体积为8383.52mm~3。肿瘤表面积在114.21mm~2至9482.13mm~2范围内,平均肿瘤表面积为2149.32mm~2。测量的最大肿瘤浸润深度44.05mm,最小肿瘤浸润深度为4.79mm,平均肿瘤浸润深度为15.28mm。截止至2024年02月,患者的术后随访年限为0～37个月,中位随访时间为17个月,整个随访组患者死亡10例。Ki-67增殖指数与经MRI测量的肿瘤体积呈正相关(r=0.291,p<0.05),还与测量的肿瘤表面积呈正相关(r=0.279,p<0.05),但Ki-67增殖指数与肿瘤的浸润深度未见明显的相关性。肿瘤边缘光滑组与边缘模糊组的中位Ki-67增殖指数分别为40(25～50)和60(40～70),差异有统计学意义(p<0.05);肿瘤内不均匀强化组与均匀强化组的中位Ki-67增殖指数分别为60(40～70)和35(20～40),差异有统计学意义(p=0.005);肿瘤边缘外存在强化组与不存在强化组的中位Ki-67增殖指数分别为60(40～70)和35(27.5～45),差异有统计学意义(p<0.05)。肿瘤分化较好的组的中位Ki-67增殖指数为40(30～60),分化较差的组的中位Ki-67增殖指数为60(40～80),差异有统计学意义(p<0.05)。肿瘤分期较小的患者(T1-T3)占比86.8%,中位Ki-67增殖指数为40(30～60),T4期肿瘤组的中位Ki-67增殖指数为70(45～82.5),差异有统计学意义(p<0.05)。绘制Ki-67增殖指数、肿瘤体积、表面积和浸润深度与淋巴结转移的ROC曲线,以最佳截断值将研究对象分为两组,并进行淋巴结转移的单因素和多因素分析,发现Ki-67增殖指数、肿瘤体积、表面积可独立预测颈淋巴结转移,其中Ki-67增殖指数联合肿瘤体积的回归模型预测效能最佳。76例患者进行单因素生存分析,并绘制生存曲线,颈部转移性淋巴结对患者生存有显著影响(p<0.001),肿瘤表面积和肿瘤浸润深度较大者总生存率较低,差异有统计学意义(p<0.05)。结论:1.术前可通过MRI上肿瘤的三维及形态学特征预测TSCC患者的Ki-67表达趋势;2.MRI来源的肿瘤表面积和肿瘤浸润深度与TSCC患者的总体生存相关,且相比二维层面上的肿瘤浸润深度,肿瘤的三维特征可能是一个更好的预后因素;3.Ki-67作为肿瘤增殖标志物,可用来预测TSCC的侵袭性,与颈淋巴结转移相关,对该蛋白的表达进行预测分析可对术前手术方案的制定提供参考。图11幅,表18个,参考文献64篇更多还原

【Abstract】 Objective:To investigate the relationship between tumor volume,surface area,depth of invasion,tumor morphological features on MRI and Ki-67 proliferation index of tongue squamous cell carcinoma(TSCC)based on MRI measurement,and to further explore their relationship with prognosis.Methods:A retrospective study was conducted on 76 patients diagnosed with TSCC in the department of oral and maxillofacial surgery of Second Xiangya Hospital of Central South University from February2021 to July 2023 were enrolled.The clinical data,MRI data and survival data were collected.Tumor volume,surface area and infiltration depth of MRI images were measured in 3D-Slicer software.The morphological characteristics of the tumor were observed and recorded on the enhanced images,including intratumoral and tumor edge enhancement patterns.The relationship between MR imaging parameters and Ki-67 proliferation index was analyzed.The patients were followed up to analyze the correlation between MR imaging parameters and Ki-67 proliferation index and prognosis.Results:The Ki-67 proliferation index of 76 patients ranged between5 and 90,with a median of 42.5.The tumor volume measured by3D-Slicer software was in the range of 334.47mm~3 to 56454.2mm~3,and the average tumor volume was 8383.52mm~3.The tumor surface area was within 114.21mm~2 to 9482.13mm~2,and the average tumor surface area was 2149.32mm~2.The measured maximum depth of invasion was44.05mm,the minimum depth was 4.79mm and the average depth was15.28mm.As of February 2024,the postoperative follow-up period of the patients was 0-37 months,with a median follow-up period of 17 months.Ten patients died in the entire follow-up group.Ki-67 proliferation index was positively correlated with tumor volume measured by MRI(r=0.291,p<0.05),and also positively correlated with the measured tumor surface area(r=0.279,p<0.05),but there was no significant correlation between the Ki-67 proliferation index and tumor depth of invasion.The median Ki-67 proliferation index was 40(25-50)in the smooth margin group and 60(40-70)in the blurred margin group,and the difference was statistically significant(p<0.05).The median Ki-67proliferation index of the heterogeneous enhancement group and the homogeneous enhancement group were 60(40-70)and 35(20-40),respectively,and the difference was statistically significant(p=0.005).The median Ki-67 proliferation index was 60(40-70)and 35(27.5-45)in the group with and without enhancement outside the tumor margin,respectively,and the difference was statistically significant(p<0.05).The median Ki-67 proliferation index in the well-differentiation tumor group was 40(30-60),and the median Ki-67 proliferation index in the poor-differentiation group was 60(40-80),with a statistically significant difference(p<0.05).The proportion of patients with lower tumor stage(T1-T3)was 86.8%,and the median Ki-67 proliferation index was 40(30-60).The median Ki-67 proliferation index in the T4tumor group was 70(45-82.5),and the difference was statistically significant(p<0.05).The ROC curves of Ki-67 proliferation index,tumor volume,surface area,depth of invasion and lymph node metastasis were drawn.The subjects were divided into two groups with the best cut-off value,and univariate and multivariate analysis of lymph node metastasis was performed.It was found that Ki-67 proliferation index,tumor volume and surface area could independently predict cervical lymph node metastasis,and the regression model of Ki-67 proliferation index combined with tumor volume had the best predictive efficacy.Univariate survival analysis was performed on 76 patients,and the survival curve was drawn.Metastatic lymph nodes in the neck had a significant effect on the survival of patients(p<0.001).The overall survival rate was lower in patients with larger tumor surface area and depth of tumor invasion,and the difference was statistically significant(p<0.05).Conclusion:1.The Ki-67 proliferation index of TSCC patients can be predicted by the three-dimensional and morphological characteristics of tumors on preoperative MRI;2.The tumor surface area and depth of invasion derived from MRI are related to the overall survival of TSCC patients,and compared with the depth of tumor invasion at the two-dimensional level,the three-dimensional analysis of tumors may be a better prognostic factor;3.Ki-67,as a tumor proliferation marker,can be used to predict the invasiveness of TSCC tumors,it can be used to predict cervical lymph node metastasis,the prediction of this protein can provide a reference for preoperative surgical planning.更多还原