目的：评估多层螺旋CT（Multi slice computed tomography，MSCT）对进展期胃癌Lauren分型的应用价值。方法：回顾性分析114例经手术病理证实的进展期胃癌的MSCT影像学表现，以Lauren分型标准分为肠型胃癌和弥漫型胃癌两组，比较两组进展期胃癌的肿瘤厚度、长径、门脉期CT值、强化方式、肿瘤表面有无溃疡情况、淋巴结分期。结果：肠型和弥漫型胃癌分别为50例和64例，两组厚度分别为（18.42±7.40） mm和（17.17±5.14） mm，差异无统计学意义（t=1.07，P=0.29）；长径分别为（50.70±17.29） mm和（60.82±23.33） mm；门脉期CT值（黏液腺癌除外）分别为（75.75±15.81） HU和（85.80±18.17） HU；强化方式：（均匀∶不均匀=27∶23和21∶43）；表面情况：（平坦∶溃疡=13∶37和32∶32）；以上差异均有统计学意义，分别为（t=-2.57，P=0.01），（t=-3.05，P=0.00），（χ2=5.17，P=0.02），（χ2=6.77，P=0.01）；淋巴结分期与病理对照符合率分别为84.00%与81.25%。结论：MSCT对进展期胃癌的Lauren分型有较大价值，两型进展期胃癌在肿瘤长径、门脉期CT值（黏液腺癌除外）、强化方式及肿瘤表面有无溃疡方面均有较大差异，CT对胃癌淋巴结分期有较高符合率。
Abstract
Objective: To investigate the value of multi-slice computed tomography(MSCT) in Lauren classification of advanced gastric carcinoma. Methods: MSCT imaging findings of 114 patients with advanced gastric cancer proved by operation or gastroscopy biopsy were analyzed retrospectively. All cases were divided into two groups, intestinal-type(IT) and diffuse-type (DT), according to Lauren classification standard. The thickness, long diameters, CT values of portal venous phase, enhancement patterns and surface of the tumor were compared between the two groups. Results: A total of 50 and 64 cases were found in IT and DT gastric carcinoma. The thickness of two groups were (18.42±7.40) mm and (17.17±5.14) mm, the difference was not statistically significant(t=1.07, P=0.29). The long diameters were (50.70±17.29) mm and (60.82±23.33) mm, CT values in portal venous phase(except mucinous adenocarcinoma)(75.75±15.81) HU and (85.80±18.17) HU, enhancement types(homogeneous:inhomogeneous)=(27:23) and (21:43), surface condition of the tumor(flat:ulcer)=(13:37) and (32:32), the differences were statistically significant, respectively(t=-2.57, P=0.01), (t=-3.05, P=0.00), (χ2=5.17, P=0.02), (χ2=6.77, P=0.01). The coincidence rates of lymph node staging and pathological contrast were 84.00% and 81.25% respectively. Conclusion: MSCT has important value in Lauren classification of advanced gastric carcinoma. There are significant differences in the long diameters, CT values in portal venous phase(except mucinous adenocarcinoma), enhancement types and surface characteristics between IT and DT gastric tumor. CT has high coincidence rate with lymph node staging in gastric cancer.
关键词
胃肿瘤 /
肿瘤分期 /
体层摄影术 /
螺旋计算机
Key words
Stomach neoplasms /
Neoplasm staging /
Tomography, spiral computed
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参考文献
[1]Okines A, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2010, 21 Suppl 5(5): v50-v54.
[2]Lauren P. The two histological main types of gastric carcinoma: Diffuse and, so-called Intestinal-type carcinoma. An attempt at a histo-clinical classification[J]. Acta Pathologica Et Microbiologica Scandinavica, 1965, 64(1): 31-49.
[3]Kim JW, Shin SS, Heo SH, et al. Diagnostic performance of 64-section CT using CT gastrography in preoperative T staging of gastric cancer according to 7th edition of AJCC cancer staging manual[J]. Eur Radiol, 2012, 22(3): 654-662.
[4]权继传，解亦斌，田艳涛. 国际抗癌联盟胃癌TNM分期系统第七版解读[J]. 中华诊断学电子杂志，2014，2（1）：59-61.
[5]杨洁，武赞凯，李连顺，等. 胃癌Lauren分型研究进展[J]. 中南大学学报：医学版，2015，40（8）：934-1040.
[6]Kim Y, Ejaz A, Spolverato G, et al. Conditional Survival after Surgical Resection of Gastric Cancer: A Multi-Institutional Analysis of the US Gastric Cancer Collaborative[J]. Ann Surg Oncol, 2015, 22(2): 557-564.
[7]Rosa F, Alfieri S, Tortorelli AP, et al. Trends in clinical features, postoperative outcomes, and long-term survival for gastric cancer: a Western experience with 1278 patients over 30 years[J]. World J Surg Oncol, 2013, 12(1): 1-11.
[8]Qiu MZ, Cai MY, Zhang DS, et al. Clinicopathological characteristics and prognostic analysis of Lauren classification in gastric adenocarcinoma in China[J]. J Transl Med, 2013, 11(1): 1-7.
[9]Chen YC, Fang WL, Wang RF, et al. Clinicopathological Variation of Lauren Classification in Gastric Cancer.[J]. Pathol Oncol Res, 2016, 22(1): 197-202.
[10]王锡明，武乐斌，李振家，等. Lauren分类法在胃癌CT分期及术前评估中的价值[J]. 中华消化杂志，2001，21（7）：407-409.
[11]国家重大项目“胃癌分子分型与个体化诊疗”课题组. 胃癌病理分型和诊断标准的建议[J]. 中华病理学杂志，2010，39（4）：266-269.
[12]Rossi M, Broglia L, Graziano P, et al. Local invasion of gastric cancer: CT findings and pathologic correlation using 5-mm incremental scanning, hypotonia, and water filling[J]. AJR, 1999, 172(2): 383-388.
[13]张晓丹，高剑波，李荫太，等. 螺旋CT对胃癌Lauren’s分型诊断价值的研究[J]. 临床放射学杂志，2003，22（7）：568-571.
[14]Badescu A, Georgescu CV, Vere CC, et al. Correlations between Her2 oncoprotein, VEGF expression, MVD and clinicopathological parameters in gastric cancer[J]. Romanian J Morphol Embryol, 2012, 53(4): 997-1005.
[15]Shimada S, Mimata A, Sekine M, et al. Synergistic tumour suppressor activity of E-cadherin and p53 in a conditional mouse model for metastatic diffuse-type gastric cancer[J]. Gut, 2012, 61(3): 344-353.
[16]邓程伟，申竑. 胃癌 Lauren分型与其临床病理特点及预后的关系[J]. 实用癌症杂志，2014，卷（4）：394-396.
[17]丁昌懋，张惠宇，孙慧芳，等. 胃癌MSCT征象与VEGF-C、VEGFR-3表达关系的研究[J]. 胃肠病学和肝病学杂志，2015，24（5）：561-564.
