能谱CT联合肿瘤标志物预测肺腺癌Ki-67表达

窦沛沛; 赵恒亮; 曹爱红

doi:10.15953/j.ctta.2022.172

能谱CT联合肿瘤标志物预测肺腺癌Ki-67表达

doi: 10.15953/j.ctta.2022.172

窦沛沛^{1, 2,},
赵恒亮^{2, 3},
曹爱红^1, ,

1.
徐州医科大学第二附属医院影像科, 江苏徐州221006
2.
徐州医科大学医学影像学院, 江苏徐州221006
3.
徐州医科大学附属医院影像科, 江苏徐州221006

基金项目: 徐州市卫生健康委员会青年医学科技创新项目（XWKYHT20210563）。

详细信息

作者简介:
窦沛沛：女，徐州医科大学第二附属医院影像科医师，徐州医科大学影像医学与核医学专业在读博士，主要从事CT成像及诊断等方面的研究，E-mail：1062920760@qq.com

曹爱红：男，博士，徐州医科大学第二附属医院影像科主任医师、硕士研究生导师，主要从事CT/MR、X线等医学影像诊断，E-mail：caooh@163.com

通讯作者:
曹爱红*，

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出版历程
- 收稿日期: 2022-08-25
- 修回日期: 2023-01-15
- 录用日期: 2023-01-16
- 网络出版日期: 2023-02-27

Spectral CT Combined with Tumor Markers to Predict Ki-67 Expression in Lung Adenocarcinoma

DOU Peipei^{1, 2
,},
ZHAO Hengliang^{2, 3},
CAO Aihong^{1
, ,}

1.
Department of Radiology, the Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
2.
The School of medical Imaging , Xuzhou Medical University, Xuzhou 221006, China
3.
Department of Radiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China

摘要

摘要: 目的：探讨能谱CT定量参数联合血清肿瘤标志物（CEA、CA-125）对肺腺癌Ki-67表达的预测价值。方法：回顾性分析2020年6月至2022年2月经病理证实为肺腺癌的64例患者临床病理及影像学资料，所有患者均行双期能谱CT检查，且疗前血清CEA、CA-125水平明确。根据术后病理结果分为Ki-67高表达组（＞30％）、Ki-67低表达组（≤30％）。经双能量后处理工作站测得能谱相关定量参数碘值（IC），标准化碘比率（NIC）及能谱曲线斜率（λHU），根据病历资料获取疗前血清CEA、CA-125表达水平。采用t/Mann-Whitney U检验、χ²检验比较两组间各参数的差异，采用ROC曲线评估参数的预测效能。结果：Ki-67低表达组静脉期IC、NIC和λHU值均高于高表达组，组间差异有统计学意义；Ki-67高表达组血清CEA、CA-125水平高于低表达组，组间差异有统计学意义；其他参数组间差别无统计学意义。ROC曲线分析显示多因素联合指标对Ki-67的预测效能明显高于各单因素指标，曲线下面积为0.754，敏感度为77.78％，特异度为72.97％。结论：静脉期能谱CT定量参数、血清CEA及CA-125水平对预测Ki-67表达有一定价值，能够为临床治疗方案的选择提供一定依据。
- 能谱CT /
- 肺腺癌 /
- 肿瘤标志物 /
- Ki-67
Abstract: Purpose: To investigate the predictive value of energy spectrum CT quantitative parameters combined with serum tumor markers (CEA, CA-125) on ki-67 expression in lung adenocarcinoma. Methods: The clinicopathological and imaging data of 64 patients with lung adenocarcinoma confirmed by pathology from June 2020 to February 2022 were retrospectively analyzed. All patients underwent dual-phase energy spectrum CT examination, and serum CEA and CA-125 levels before treatment were clear. Based on postoperative pathological results, patients were divided into two groups, the high expression group of Ki-67 (>30%) and the low expression group of Ki-67 (≤30%). The iodine value (IC), standardized iodine ratio (NIC), and the slope of the energy spectrum curve (λHU) were measured by a dual-energy post-processing workstation. The expression levels of SERUM CEA and CA-125 before treatment were obtained according to medical records. Statistical analysis of the data was performed with SPSS22.0; t-test or Mann−Whitney U test and χ² tests were used to compare the differences in parameters between the two groups, and the ROC (receiver operating characteristic curve, ROC) curve was used to evaluate the prediction efficiency of the parameters. Results: The IC, NIC, and λHU values in the low expression group were higher than those of the high expression group, and the differences were statistically significant. Serum CEA and CA-125 levels in the ki-67 high expression group were higher than those of the low expression group, and the difference was statistically significant. There were no significant differences in other parameters between the two groups. ROC curve analysis showed that CEA had the best predictive efficiency for KI-67, with an area under the curve of 0.697, sensitivity of 39.17%, and specificity of 100%. Conclusions: The quantitative parameters of energy spectrum CT in the venous phase, serum CEA, and CA12-5 levels have a certain value in predicting the expression of KI-67, which can provide a basis for selecting a clinical treatment plan.
- energy spectrum CT /
- lung adenocarcinoma /
- tumor markers /
- Ki-67

HTML全文

图 1 能谱CT虚拟成像

Figure 1. Spectral CT virtual imaging

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图 2 病例CT图像特征示意图，患者男，62岁，右肺下叶肺腺癌

Figure 2. Schematic diagram of CT images of one case. The patient is a 62-year-old male with adenocarcinoma of the lower lobe of the right lung

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图 3 各参数预测Ki-67的ROC曲线分析

Figure 3. ROC curve analysis of Ki-67 prediction parameters

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图 4 多因素联合指标预测Ki-67的ROC曲线分析

Figure 4. ROC curve analysis of multi-factor combined index prediction Ki-67

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表 1 Ki-67高低表达组间临床及影像学特征比较（n=64）

Table 1. Comparison of clinical and imaging characteristics between the high and low Ki-67 expression groups（n=64）

项目	参数	例数（百分比）	低表达组	高表达组	P
性别	男性	31（48.4）	14	17	0.994
性别	女性	33（51.6）	18	15	0.994
年龄（平均数，岁）	≤62	31（48.4）	18	13	0.604
年龄（平均数，岁）	＞62	33（51.6）	14	19	0.604
结节或肿块/cm	结节（≤3）	30（46.9）	17	13	0.113
结节或肿块/cm	肿块（＞3）	34（53.1）	15	19	0.113
长径（中位数，mm）	≤32	34（53.1）	22	12	0.735
长径（中位数，mm）	＞32	30（46.9）	10	20	0.735
短径（中位数，mm）	≤23	32（50.0）	20	12	0.351
短径（中位数，mm）	＞23	32（50.0）	12	20	0.351

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表 2 高、低Ki-67表达组间能谱定量参数、血清肿瘤标志物水平比较（n=64）

Table 2. Comparison of quantitative parameters of the energy spectrum and serum tumor markers between the high and low Ki-67 expression groups（n=64）

项目	参数	低表达组（$ \overline X $±S）	高表达组（$ \overline X $±S）	P
动脉期	IC	1.182±0.253	0.870±0.090	0.984
	NIC	0.125±0.024	0.998±0.012	0.727
	λHU	1.788±0.305	1.240±0.097	0.702
静脉期	IC	1.782±0.203	1.122±0.213	0.020
	NIC	0.405±0.041	0.227±0.025	0.026
	λHU	2.399±0.295	1.458±0.107	0.013
血清肿瘤标志物	CEA	12.081±3.375	42.468±11.322	0.032
血清肿瘤标志物	CA-125	4.337±0.884	9.106±1.703	0.045
注：低表达组：Ki-67＜30％；高表达组：Ki-67≥30％；IC：碘值；NIC：标准化碘比率；λHU：40 keV-100 keV之间的能谱衰减　　　曲线斜率；CEA：癌胚抗原；CA-125：糖类抗原；粗体表示高低Ki-67组间存在显著性差异（P＜0.05）。

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表 3 能谱参数及血清肿瘤标志物水平预测Ki-67的效能

Table 3. Efficacy of energy spectrum parameters and serum tumor marker levels in predicting Ki-67

参数	AUC	截断值	敏感性/％	特异性/％	P
CEA	0.697	44.07	39.13	100.00	0.019
CA-125	0.688	5.26	52.17	88.24	0.026
*IC	0.669	1.00	48.39	81.82	0.014
*NIC	0.662	25.3	54.84	78.79	0.019
*λHU	0.680	1.19	41.94	93.94	0.008
注：CEA：癌胚抗原；CA-125：糖类抗原；*：静脉期；IC：碘值；NIC：标准化碘比率；λHU：40～100 keV之间的能谱衰减曲　　　线斜率。

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表 4 多因素联合指标预测Ki-67的效能

Table 4. Prediction of Ki-67 performance by multiple factors combined with indicators

参数	AUC	敏感性/％	特异性/％	P
联合指标	0.754	77.78	72.97	＜0.01
注：联合指标：各项单因素指标（CEA、CA-125及静脉期IC、NIC、λHU）逻辑回归后所生成的多因素联合指标。

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