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

doi:10.3969/j.issn.1671-7171.2024.09.012

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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.

Key words： Colorectal Neoplasms Liver Neoplasms Neoplasm Metastasis Ultrasonography Genes Prognosis

Received: 09 June 2024

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R735.7

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http://journal07.magtech.org.cn/yxlcyj/EN/10.3969/j.issn.1671-7171.2024.09.012 OR http://journal07.magtech.org.cn/yxlcyj/EN/Y2024/V41/I9/1322

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