Application Value of Ultrasound, Gene Mutation and Clinical Characteristics in Prognosis Evaluation of Colorectal Cancer Patients with Liver Metastasis
WANG Xinrong, YANG Zhihui, QIANG Yan, et al
Baotou Shiguai District Hospital, Baotou Inner Mongolia 014070
摘要【目的】探讨超声、基因突变及临床特征在结直肠癌肝转移(Colorectal cancer liver metastasis,CRLM)患者预后中的评估价值。【方法】选取2023年6月至2024年5月包头市石拐区医院收治的100例CRLM患者,均行普通超声和超声造影检查,记录超声定量参数[上升时间(RT)、平均渡越时间(mTT)、峰值强度(PE)、流入相曲线下面积(WiAUC)、流入相比率(WiR)和流入相灌注指数(WiPI)];同时记录CRLM患者的总生存期(OS)和无进展生存期(PFS);单因素和多因素分析CRLM患者PFS、OS的影响因素,构建预测CRLM患者预后模型,绘制受试者工作特征(ROC)曲线验证。【结果】单因素分析结果显示:病灶转移位置、原发肿瘤分化程度、原发肿瘤浸润深度、Ki-67表达、PT、WiR、术前癌胚抗原(CEA)、淋巴结转移数、原发肿瘤直径及K-RAS基因、NRAS基因和BRAF基因突变与较差的OS相关(P<0.05)。多因素分析结果显示:原发肿瘤分化程度、原发肿瘤浸润深度、Ki-67表达、术前CEA、淋巴结转移数及K-RAS基因、NRAS基因和BRAF基因突变为OS较差的独立影响因素(P<0.05)。单因素分析结果显示:原发肿瘤分化程度、原发肿瘤浸润深度、Ki-67表达、PT、WiR、WiPI、术前CEA及K-RAS基因、NRAS基因和BRAF基因突变与较差的PFS相关(P<0.05)。多因素分析结果显示:原发肿瘤分化程度、原发肿瘤浸润深度、Ki-67表达、淋巴结转移数及K-RAS基因、NRAS基因、BRAF基因突变为PFS较差的独立影响因素(P<0.05)。根据多因素分析结果拟合CRLM患者RFS预后模型为Logit(P)=-3.285＋0.408×原发肿瘤分化程度＋0.569×原发肿瘤浸润深度＋0.674×Ki-67表达＋0.634×K-RAS基因突变＋0.534×NRAS基因突变＋0.522×BRAF基因突变。ROC曲线分析结果显示:曲线下面积为0.884,敏感度为0.795,特异性为0.800。【结论】CRLM患者预后受原发肿瘤分化程度、原发肿瘤浸润深度、Ki-67表达及K-RAS基因、NRAS基因和BRAF基因突变等因素的影响,建立预测模型可对患者预后情况进行更好地判断。
Abstract：【Objective】To investigate the prognostic value of ultrasound, gene mutation and clinical features in patients with colorectal cancer liver metastasis (CRLM). 【Methods】A total of 100 patients with CRLM admitted to the Shiguai District Hospital of Baotou City from June 2023 to May 2024 were selected and underwent ordinary ultrasound and contrast-enhanced ultrasound examination. The quantitative parameters of ultrasound [rise time (RT), mean transit time (mTT), peak intensity (PE), area under the inflow phase curve (WiAUC), inflow ratio (WiR) and inflow phase perfusion index (WiPI)] were recorded; The overall survival (OS) and progression free survival (PFS) of crlm patients were recorded at the same time; The influencing factors of PFS and OS in CRLM patients were analyzed by univariate and multivariate analysis, and the prognostic model of CRLM patients was constructed, and the receiver operating characteristic (ROC) curve was drawn for verification. 【Results】Univariate analysis showed that the location of lesion metastasis, the differentiation degree of primary tumor, the depth of primary tumor invasion, Ki-67 expression, PT, WiR, preoperative carcinoembryonic antigen (CEA), the number of lymph node metastasis, the diameter of primary tumor and K-RAS gene, NRAS gene and BRAF gene mutations were associated with poor OS (P<0.05); Multivariate analysis showed that the degree of primary tumor differentiation, depth of primary tumor invasion, Ki-67 expression, preoperative CEA, lymph node metastasis, and K-RAS gene, NRAS gene, and BRAF gene mutations were independent influencing factors for poor OS (P<0.05). Univariate analysis showed that the degree of primary tumor differentiation, depth of primary tumor invasion, Ki-67 expression, PT, WiR, WiPI, preoperative CEA and K-Kas gene, NRAS gene and BRAF gene mutations were associated with poor PFS (P<0.05); Multivariate analysis showed that the degree of primary tumor differentiation, the depth of primary tumor invasion, Ki-67 expression, the number of lymph node metastasis and K-RAS gene, NRAS gene, BRAF gene mutation were the independent influencing factors of poor PFS (P<0.05). According to the results of multivariate analysis, the RFS prognosis model of CRLM patients was fitted as logit (P)=-3.285+0.408×primary tumor differentiation+0.569 × primary tumor invasion depth + 0.674×Ki-67 expression+0.634×K-RAS gene mutation + 0.534×NRAS gene mutation+0.522×BRAF gene mutation. ROC curve analysis showed that the area under the curve was 0.884, the sensitivity was 0.795, and the specificity was 0.800. 【Conclusion】 The prognosis of patients with CRLM is affected by the degree of differentiation of the primary tumor, the depth of invasion of the primary tumor, Ki-67 expression and K-RAS gene, NRAS gene and BRAF gene mutations. The establishment of a prediction model can better judge the prognosis of patients.
王新荣, 杨智慧, 强艳, 杨晓慧, 孙乔曦媛. 超声、基因突变及临床特征在结直肠癌肝转移患者预后评估中的应用价值[J]. 医学临床研究, 2024, 41(9): 1322-1326.
WANG Xinrong, YANG Zhihui, QIANG Yan, et al. Application Value of Ultrasound, Gene Mutation and Clinical Characteristics in Prognosis Evaluation of Colorectal Cancer Patients with Liver Metastasis. JOURNAL OF CLINICAL RESEARCH, 2024, 41(9): 1322-1326.
2024, Vol. 41 
