CT肌肉特征指标对结直肠癌患者化疗敏感程度的预测价值

doi:10.3760/cma.j.cn441417-20241223-16024

摘要/Abstract

摘要：

目的　探究结直肠癌（colorectal cancer，CRC）患者CT肌肉特征指标水平，分析CT肌肉特征指标对CRC患者化疗敏感性的预测价值。方法　本研究为回顾性分析。选取汉中市中心医院2020年9月至2023年8月收治的120例CRC患者为研究对象。所有患者均进行奥沙利铂联合卡培他滨化疗。化疗结束后根据治疗结果将患者分为化疗敏感组（52例）和化疗不敏感组（68例）。化疗前及化疗结束后检测患者骨骼肌指数（skeletal muscle index，SMI）、腰大肌指数（psoas muscle index，PMI）、骨骼肌放射性密度（skeletal muscle radiodensity，SMD）及肌间脂肪含量（intermuscular adipose tissue，IMAT）等肌肉特征指标。采用χ²检验、t检验比较两组数据。采用多因素logistic回归分析影响化疗敏感性的肌肉特征指标。采用受试者操作特征曲线（receiver operating characteristic curve，ROC）分析肌肉特征指标对化疗敏感性的预测价值。结果　治疗前，化疗敏感组SMI、PMI、SMD分别为（49.69±9.55）cm²/m²、（4.57±0.89）cm²/m²、（34.31±4.42）HU，均高于化疗不敏感组的（44.02±7.95）cm²/m²、（4.16±0.84）cm²/m²、（31.78±4.73）HU，而化疗敏感组IMAT为（7.04±0.89）%，低于化疗不敏感组的（7.42±0.95）%，差异均有统计学意义（t=3.290、2.416、2.818、2.105，均P<0.05）。治疗后，化疗敏感组SMI、PMI、SMD分别为（52.16±9.58）cm²/m²、（4.93±0.87）cm²/m²、（36.11±4.58）HU，均高于化疗不敏感组的（47.51±7.94）cm²/m²、（4.23±0.85）cm²/m²、（32.40±4.69）HU，而IMAT为（6.69±0.87）%，低于化疗不敏感组的（7.05±0.82）%，差异均有统计学意义（t=2.695、4.150、4.081、2.171，均P<0.05）。多因素logistic回归分析显示，SMI（OR=1.090，95%CI 1.031～1.151）、PMI（OR=1.728，95%CI 1.016～2.937）、SMD（OR=1.140，95%CI 1.031～1.260）是结肠癌患者化疗敏感的独立危险因素，而IMAT（OR=0.566，95%CI 0.338～0.946）是化疗敏感的独立保护因素（均P<0.05）。SMI、PMI、SMD和IMAT的曲线下面积（AUC）分别为0.664、0.662、0.607、0.614，联合预测的AUC为0.830（P<0.05）。结论　CT肌肉特征指标PMI、SMI、SMD和IMAT对CRC患者的化疗敏感性具有较高的预测能力。

关键词:

结直肠癌, CT肌肉特征指标, 奥沙利铂, 卡培他滨, 化疗敏感度

Abstract:

Objective　To explore the levels of CT muscle characteristic indicators in patients with colorectal cancer (CRC), and to analyze the predictive value of CT muscle characteristic indicators for the sensitivity of patients with colorectal cancer to chemotherapy. Methods　This was a retrospective study. A total of 120 patients with CRC treated at Hanzhong City Center Hospital from September 2020 to August 2023 were selected as the study objects. Oxaliplatin and capecitabine were administered by all the patients. After the chemotherapy, the patients were divided into a chemotherapy sensitive group (52 cases) and a chemotherapy insensitive group (68 cases) according to the treatment results. The CT muscle characteristic indicators, including skeletal muscle index (SMI), psoas muscle index (PMI), skeletal muscle radiodensity (SMD), and intermuscular adipose tissue (IMAT), were detected before and after the chemotherapy. The data in the two groups were compared by χ² test and t test. The multivariate logistic regression was used to analyze the CT muscle characteristic indicators affecting chemotherapy sensitivity. The predictive value of CT muscle characteristic indicators for chemotherapy sensitivity was analyzed by the receiver operating characteristic curve (ROC). Results　Before the treatment, the SMI, PMI, and SMD in the chemotherapy sensitive group were higher than those of the chemotherapy insensitive group [(49.69±9.55) cm²/m² vs. (44.02±7.95) cm²/m², (4.57±0.89) cm²/m² vs. (4.16±0.84) cm²/m², and (34.31±4.42) HU vs. (31.78±4.73) HU], and the IMAT was lower [(7.04±0.89)% vs. (7.42±0.95)%], with statistical differences (t=3.290, 2.416, 2.818, and 2.105; all P<0.05). After the treatment, the SMI, PMI, and SMD in the chemotherapy sensitive group were higher than those in the chemotherapy insensitive group [(52.16±9.58) cm²/m² vs. (47.51±7.94) cm²/m², (4.93±0.87) cm²/m² vs. (4.23±0.85) cm²/m², and (36.11±4.58) HU vs. (32.40±4.69) HU], and the IMAT was lower [(6.69±0.87)% vs. (7.05±0.82)%], with statistical differences (t=2.695, 4.150, 4.081, and 2.171; all P<0.05). The multifactorial logistic regression analysis showed that SMI (OR=1.090, 95%CI 1.031-1.151), PMI (OR=1.728, 95%CI 1.016-2.937), and SMD (OR=1.140, 95%CI 1.031-1.260) were the independent risk factors for chemotherapy sensitivity of the patients, and IMAT (OR=0.566, 95%CI 0.338-0.946) was an independent protective factor for chemotherapy sensitivity (all P<0.05). The areas under the curves (AUC) of SMI, PMI, SMD, and IMAT were 0.664, 0.662, 0.607, and 0.614, respectively; the AUC of their combination was 0.830 (P<0.05). Conclusion　CT muscle characteristic indicators, PMI, SMI, SMD, and IMAT, have high predictive values for chemotherapy sensitivity in patients with CRC.

Key words:

Colorectal cancer, CT muscle characteristic indicators, Oxaliplatin, Capecitabine, Chemotherapy sensitivity

陈堃刘亚良秦书敏盛杰鑫杨琳郝阳.

CT肌肉特征指标对结直肠癌患者化疗敏感程度的预测价值 [J]. 国际医药卫生导报, 2025, 31(16): 2761-2765.

Chen Kun, Liu Yaliang, Qin Shumin, Sheng Jiexin, Yang Lin, Hao Yang.

Predictive value of CT muscle characteristic indicators for chemotherapy sensitivity in patients with rectal cancer [J]. International Medicine and Health Guidance News, 2025, 31(16): 2761-2765.

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