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目的:探讨CT灌注参数和VEGF(vascular endothelial growth factor,VEGF)表达对非小细胞肺癌放疗后近期疗效评价和预测价值。方法:收集2010年4月~2013年11月我院病理证实非小细胞肺癌患者58例。所有患者在放射治疗前和放射治疗结束4周后分别行肺部肿瘤CT灌注扫描,并对患者病理切片行VEGF染色。比较非小细胞肺癌在放疗前和放疗后各灌注参数:血流量BF(blood flow,BF)、血容量BV(blood volume,BV)、平均通过时间MTT(mean transit time,MTT)、表面通透性PS(permeability surface,PS)、肿块动脉强化峰值PH(peak height,PH)的变化,同时比较VEGF阳性表达组和VEGF阴性表达组各灌注参数变化值差异,以及放疗后肿瘤有效(完全或部分缓解)组与无效(稳定或进展)组各灌注参数变化值及VEGF表达差异,通过ROC法评价放疗前各灌注参数对非小细胞肺癌放疗后近期疗效的预测诊断价值,并对VEGF表达情况对非小细胞肺癌接受放疗后近期疗效影响进行分析。结果:放疗后病灶评价为有效(完全或部分缓解)49例,评价为无效(稳定或进展)9例。非小细胞肺癌放疗后BF(t=6.282,P=0.000)、BV(t=5.230,P=0.000)、PH(t=3.954,P=0.009)值均较放疗前明显降低。VEGF阳性表达组患者肿瘤放疗前后BF(t=5.222,P=0.000)、BV(t=4.121,P=0.006)、PH(t=3.654,P=0.013)降低值较VEGF阴性表达组明显。同时放疗后评价为有效组肿瘤灌注参数BF(t=6.122,P=0.000)、BV(t=5.221,P=0.000)、PH(t=2.854,P=0.032)降低值均较无效组明显。VEGF阳性表达组非小细胞肺癌放疗后缓解率较VEGF阴性表达组高(χ2=8.145,P=0.004)。ROC分析结果表明肿瘤血流量BF(AUC=0.827,P=0.000)、血容量BV(AUC=0.887,P=0.000)不仅AUC>0.5,且与AUC为0.5的曲线差异有统计学意义。结论:非小细胞肺癌放疗前肿瘤灌注参数中的BF、BV与VEGF对评价和预测非小细胞肺癌放疗后近期疗效有价值。
Objective: To evaluate the short-term efficacy and predictive value of CT perfusion parameters and VEGF expression in non-small cell lung cancer after radiotherapy. Methods: From April 2010 to November 2013, 58 cases of non-small cell lung cancer were confirmed by pathology in our hospital. All patients underwent CT perfusion imaging of lung tumor before radiotherapy and 4 weeks after the end of radiotherapy, and VEGF staining was performed on the pathological sections of the patients. The perfusion parameters of non-small cell lung cancer before and after radiotherapy were compared: blood flow (BF), blood volume (BV), mean transit time (MTT) (PS) and peak height (PH), and to compare the changes of perfusion parameters between VEGF-positive and VEGF-negative groups, as well as the effective tumor after radiotherapy (complete or partial Remission group and invalid (stable or progressive) group perfusion parameter changes and VEGF expression differences by ROC method to evaluate the perfusion parameters before radiotherapy for non-small cell lung cancer after radiotherapy for the short term efficacy of the predictive value of diagnosis, and the expression of VEGF The effect of short-term treatment after radiotherapy for non-small cell lung cancer was analyzed. RESULTS: Forty-nine patients were evaluated as effective (complete or partial) after radiotherapy and 9 as ineffective (stable or progression). BF (t = 6.282, P = 0.000), BV (t = 5.230, P = 0.000) and PH (t = 3.954, P = 0.009) after radiotherapy in NSCLC were significantly lower than those before radiotherapy. The levels of BF (t = 5.222, P = 0.000), BV (t = 4.121, P = 0.006) and PH (t = 3.654, P = 0.013) in patients with positive VEGF expression before and after radiotherapy were significantly lower than those in patients with negative VEGF. At the same time, the effective rate of tumor perfusion parameters BF (t = 6.122, P = 0.000), BV (t = 5.221, P = 0.000) and PH (t = 2.854, P = 0.032) The remission rate of VEGF-positive NSCLC patients after radiotherapy was higher than that of VEGF-negative ones (χ2 = 8.145, P = 0.004). The results of ROC analysis showed that there was significant difference between the blood flow volume BF (AUC = 0.827, P = 0.000) and blood volume BV (AUC = 0.887, P = 0.000) Conclusion: BF, BV and VEGF in tumor perfusion parameters of non-small cell lung cancer before radiotherapy are valuable in evaluating and predicting the short-term curative effect of non-small cell lung cancer after radiotherapy.