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基于MRI和微小RNA-7106-3p模型评价进展期直肠癌新辅助放化疗的疗效:127例前瞻性临床试验

程慧欣 李瑞峰 胡锋超 黄竞远 吕莹 谢宗源

程慧欣, 李瑞峰, 胡锋超, 黄竞远, 吕莹, 谢宗源. 基于MRI和微小RNA-7106-3p模型评价进展期直肠癌新辅助放化疗的疗效:127例前瞻性临床试验[J]. 分子影像学杂志, 2022, 45(5): 637-642. doi: 10.12122/j.issn.1674-4500.2022.05.02
引用本文: 程慧欣, 李瑞峰, 胡锋超, 黄竞远, 吕莹, 谢宗源. 基于MRI和微小RNA-7106-3p模型评价进展期直肠癌新辅助放化疗的疗效:127例前瞻性临床试验[J]. 分子影像学杂志, 2022, 45(5): 637-642. doi: 10.12122/j.issn.1674-4500.2022.05.02
CHENG Huixin, LI Ruifeng, HU Fengchao, HUANG Jingyuan, LÜ Ying, XIE Zongyuan. Value of the model based on MRI and microRNA-7106-3p for evaluating the efficacy of neoadjuvant chemoradiotherapy in advanced rectal cancer: a prospective study based on 127 patients[J]. Journal of Molecular Imaging, 2022, 45(5): 637-642. doi: 10.12122/j.issn.1674-4500.2022.05.02
Citation: CHENG Huixin, LI Ruifeng, HU Fengchao, HUANG Jingyuan, LÜ Ying, XIE Zongyuan. Value of the model based on MRI and microRNA-7106-3p for evaluating the efficacy of neoadjuvant chemoradiotherapy in advanced rectal cancer: a prospective study based on 127 patients[J]. Journal of Molecular Imaging, 2022, 45(5): 637-642. doi: 10.12122/j.issn.1674-4500.2022.05.02

基于MRI和微小RNA-7106-3p模型评价进展期直肠癌新辅助放化疗的疗效:127例前瞻性临床试验

doi: 10.12122/j.issn.1674-4500.2022.05.02
基金项目: 

河北省科学技术厅科技计划项目 162777139

详细信息
    作者简介:

    程慧欣,主治医师,E-mail: huixin_cheng88@163.com

Value of the model based on MRI and microRNA-7106-3p for evaluating the efficacy of neoadjuvant chemoradiotherapy in advanced rectal cancer: a prospective study based on 127 patients

  • 摘要:   目的  构建基于MRI和微小核糖核酸-7106-3p(miR-7106-3p)的列线图回归模型,探究其评价进展期直肠癌新辅助放化疗(NCRT)疗效的价值。  方法  前瞻性纳入2019年3月~2022年2月于河北省退役军人总医院就诊的直肠癌患者127例,NCRT后行全直肠系膜切除术。NCRT前1周内行MRI检查并抽取患者外周血,采用实时荧光定量聚合酶链反应法检测血清miR-7106-3p水平。进展期直肠癌NCRT的风险因素用Logistic回归分析。构建风险因素的列线图回归模型,采用决策曲线分析法、一致性指数和校准曲线评价模型进行分析。  结果  37例患者(29.13%)经NCRT后达到病理学完全缓解(pCR)(pCR组),90例(70.87%)未达到pCR(非pCR组)。pCR组的容积转运常数(Ktrans)、血管外细胞外间隙容积比(Ve)、回流速率常数(Kep)和miR-7106-3p水平均高于非pCR组,表观弥散系数(ADC)低于非pCR组(P < 0.05)。Logistic回归分析结果显示,N分期越高、ADC > 0.92×10-3 mm2/s是进展期直肠癌NCRT后pCR的独立危险因素(P < 0.05),Ktrans > 0.33 min、Ve > 0.55%、Kep > 0.54 min和miR-7106-3p > 0.31是进展期直肠癌NCRT后pCR的独立保护因素(P < 0.05)。模型C(由N分期、Ktrans、Ve、Kep、ADC和miR-7106-3p构成)的一致性指数为0.977,高于模型A(由Ktrans、Ve、Kep和ADC构成,0.957)和模型B(由N分期、Ktrans、Ve、Kep和ADC构成,0.956)。模型B的平均绝对误差为0.015,低于模型A(0.017)和模型C(0.024)。阈值概率在0.10~1.0的大部分范围内,模型C的净收益高于模型A和模型B。  结论  基于MRI和miR-7106-3p的模型能较好的评价进展期直肠癌NCRT疗效。

     

  • 图  1  某患者的MRI图像

    A: 冠状位; B: 矢状位; C: 轴位T1WI; D: 轴位T2WI; E: DWI; F: DCE.

    Figure  1.  MRI imaging of a patient.

    图  2  两患者病灶组织切片图像(HE染色,×100)

    A: pCR; B: 非pCR.

    Figure  2.  Images of focal tissue sections of both patients (HE staining, ×100).

    图  3  TCGA中直肠腺癌miRNAs亚型表达的火山图

    Figure  3.  Volcanic map of miRNAs subtype expression in rectal adenocarcinoma in TCGA.

    图  4  模型及评价结果

    A~C: 列线图; D~G: 评价结果.

    Figure  4.  Model and evaluation results.

    表  1  两组患者一般资料比较

    Table  1.   Comparison of clinical data between the two groups [n(%)]

    项目 pCR组(n=37) 非pCR组(n=90) Z2 P
    年龄(岁)* 53(43,59) 54(44,58) 0.016 0.987
    性别 0.132 0.716
      男 23(62.16) 59(65.56)
      女 14(37.84) 31(34.44)
    T分期 2.359 0.125
      T3 29(78.38) 58(64.44)
      T4 8(21.62) 32(35.56)
    N分期 3.314 0.191
      N0 26(70.27) 48(53.33)
      N1 8(21.62) 27(30.00)
      N2 3(8.11) 15(16.67)
    *以中位数和四分位数间距表示.
    下载: 导出CSV

    表  2  两组MRI参数和miR-7106-3p水平比较

    Table  2.   Comparison of MRI parameters and miR-7106-3p levels between the two groups

    项目 pCR组(n=37) 非pCR组(n=90) Z/t P
    Ktrans(min)* 0.38(0.34,0.41) 0.33(0.31,0.34) 6.092 < 0.001
    Ve(%, Mean±SD 0.62±0.06 0.53±0.07 7.189 < 0.001
    Kep(min, Mean±SD 0.59±0.07 0.52±0.09 4.346 < 0.001
    ADC(×10-3 mm2/s)* 0.89(0.86, 0.91) 0.92(0.89, 0.95) 3.710 < 0.001
    miR-7106-3p* 0.34(0.32, 0.45) 0.28(0.21, 0.34) 4.837 < 0.001
    *以中位数和四分位数间距表示. Ve: 血管外细胞外间隙容积比; Kep: 回流速率常数; Ktrans: 容积转运常数; ADC: 表观弥散系数.
    下载: 导出CSV

    表  3  变量赋值

    Table  3.   Variable assignment

    变量 赋值
    T分期 T3期=0,T4期=1
    N分期 N0期=0,N1期=1,N2期=2
    Ktrans(min) ≤0.33(中位数)=0,> 0.33=1
    Ve(%) ≤0.55(中位数)=0,> 0.55=1
    Kep(min) ≤0.54(中位数)=0,> 0.54=1
    ADC(×10-3 mm2/s) ≤0.92(中位数)=0,> 0.92=1
    miR-7106-3p ≤0.31(中位数)=0,> 0.31=1
    病理学结果 pCR=0,非pCR=1
    下载: 导出CSV

    表  4  进展期直肠癌NCRT风险因素的logistic回归分析结果

    Table  4.   Logistic regression analysis of NCRT risk factors in advanced rectal cancer

    因素 β SE Wald P OR(95% CI
    T分期 1.380 0.886 2.424 0.120 3.975(0.700~22.588)
    N分期 1.134 0.568 3.989 0.046 3.109(1.021~9.465)
    Ktrans -2.914 0.853 11.672 0.001 0.054(0.010~0.289)
    Ve -3.131 0.904 11.980 0.001 0.044(0.007~0.257)
    Kep -1.976 0.829 5.682 0.017 0.139(0.027~0.704)
    ADC 3.549 1.085 10.695 0.001 34.770(4.145~291.674)
    miR-7106-3p -3.865 1.166 10.991 0.001 0.021(0.002~0.206)
    下载: 导出CSV
  • [1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. doi: 10.3322/caac.21492
    [2] Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021[J]. CA ACancer J Clin, 2021, 71(1): 7-33. doi: 10.3322/caac.21654
    [3] 中华人民共和国国家卫生健康委员会. 国家卫生健康委员会中国结直肠癌诊疗规范(2020年版)[J]. 中华外科杂志, 2020, 58(8): 561-85. doi: 10.3760/cma.j.cn112139-20200518-00390
    [4] Petrelli F, Trevisan F, Cabiddu M, et al. Total neoadjuvant therapy in rectal cancer: a systematic review and Meta-analysis of treatment outcomes[J]. Ann Surg, 2020, 271(3): 440-8. doi: 10.1097/SLA.0000000000003471
    [5] Fernandez LM, São Julião GP, Figueiredo NL, et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study[J]. Lancet Oncol, 2021, 22 (1): 43-50. doi: 10.1016/S1470-2045(20)30557-X
    [6] Zhou JL, Wang CX, Lin GL, et al. Serial circulating tumor DNA in predicting and monitoring the effect of neoadjuvant chemoradiotherapy in patients with rectal cancer: a prospective multicenter study[J]. Clin Cancer Res, 2021, 27(1): 301-10. doi: 10.1158/1078-0432.CCR-20-2299
    [7] Fokas E, Liersch T, Fietkau R, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial [J]. J Clin Oncol, 2014, 32(15): 1554-62. doi: 10.1200/JCO.2013.54.3769
    [8] 董健, 谢宗源, 李垣婕, 等. 磁共振功能成像在进展期直肠癌新辅助放化疗疗效评估中的应用[J]. 中国临床研究, 2020, 33(6): 759-63. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202006008.htm
    [9] 董健, 李垣婕, 谢宗源, 等. 进展期直肠癌新辅助放化疗疗效评估模型的建立及评价: 基于MRI和网状蛋白1C[J]. 分子影像学杂志, 2021, 44(3): 472-7. doi: 10.12122/j.issn.1674-4500.2021.03.11
    [10] Machackova T, Trachtova K, Prochazka V, et al. Tumor microRNAs identified by small RNA sequencing as potential response predictors in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy[J]. Cancer Genomics Proteomics, 2020, 17(3): 249-57. doi: 10.21873/cgp.20185
    [11] Khalighfard S, Kalhori MR, Amiriani T, et al. A systematic approach introduced novel targets in rectal cancer by considering miRNA/ mRNA interactions in response to radiotherapy[J]. Cancer Biomark, 2022, 33(1): 97-110. doi: 10.3233/CBM-210079
    [12] Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2018, 16(7): 874-901. doi: 10.6004/jnccn.2018.0061
    [13] Kim NK, Hur H. New perspectives on predictive biomarkers of tumor response and their clinical application in preoperative chemoradiation therapy for rectal cancer[J]. Yonsei Med J, 2015, 56 (6): 1461-77. doi: 10.3349/ymj.2015.56.6.1461
    [14] Molinari C, Matteucci F, Caroli P, et al. Biomarkers and molecular imaging as predictors of response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer[J]. Clin Colorectal Cancer, 2015, 14(4): 227-38. doi: 10.1016/j.clcc.2015.05.014
    [15] 孙轶群, 刘宗霖, 付彩霞, 等. DKI直方图预测局部进展期直肠癌患者预后的临床价值[J]. 肿瘤影像学, 2022, 31(2): 105-12. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYX202202001.htm
    [16] Li J, Zhang M, Wang CB. Circulating miRNAs as diagnostic biomarkers for multiple myeloma and monoclonal gammopathy of undetermined significance[J]. J Clin LabAnal, 2020, 34(6): e23233.
    [17] Tong T, Sun YQ, Gollub MJ, et al. Dynamic contrast-enhanced MRI: use in predicting pathological complete response to neoadjuvant chemoradiation in locally advanced rectal cancer[J]. J Magn Reson Imaging, 2015, 42(3): 673-80. doi: 10.1002/jmri.24835
    [18] Zou HH, Yu J, Wei Y, et al. Response to neoadjuvant chemoradiotherapy for locally advanced rectum cancer: texture analysis of dynamic contrast-enhanced MRI[J]. J Magn Reson Imaging, 2019, 49(3): 885-93. doi: 10.1002/jmri.26254
    [19] Nougaret S, Vargas HA, Lakhman Y, et al. Intravoxel incoherent motion-derived histogram metrics for assessment of response after combined chemotherapy and radiation therapy in rectal cancer: initial experience and comparison between single-section and volumetric analyses[J]. Radiology, 2016, 280(2): 446-54. doi: 10.1148/radiol.2016150702
    [20] 肖楠, 陆艳荣, 朱丽娜, 等. DWI在直肠癌术前同步放化疗疗效预测中的作用[J]. 肿瘤防治研究, 2019, 46(4): 333-7. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLFY201904009.htm
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  • 收稿日期:  2022-06-23
  • 刊出日期:  2022-09-20

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