肾透明细胞癌CT表现与病理分级的相关性及意义

摘要

Objective To investigate the correlation of pathologic grading with CT value in renal clear cell carcinoma ( RCCC) , and build predictive mathematical model of pathological grade. Methods There were 94 cases of RCCC included in the study. All of RCCC patients underwent urinary system CT scan. After recording tumor size, shape, pseudocap-sule, hemorrhage and necrosis, the clinical features, CT findings and pathological results were statistically analyzed by u-sing Fishers test. Results Pathologic grading was related to the mean CT value, CT value standard deviation, maximum CT value , CT value median, maximum diameter of the tumor, minimum diameter of the tumor, tumor shape, capsule, symptoms of hematuria and lumbago (all P < 0. 05). The chief factors were the shortest diameter of tumor, existence of pseudocapsule and standard deviation of CT values (all P <0. 01 ). Fisher's method were used to develop the discriminant function; y =0. 172 x intratumoral short diameter + 1. 093 x tumor pseudocapsule +0. 015 x the mean of CT value +0. 088 x standard deviation of CT value +0. 184 x tumor sharp-2. 929 , criterion y = ( -0.427 + 1.058)/2 =0. 30. Judging accuracy, sensitivity and specificity is 77.7% , 74. 1% and 79. 1% , respecitively. Conclusions CT value and performance of RCCC is closely related to its pathologic grading. The chief factors involved the shortest diameter of tumor, the existence of pseudocapsule and CT value( standard deviation). According to the calculation based on discriminant function, if y < 0. 30, the tumor differentiation is good; if y > 0. 30, the tumor differentiation is poorly.%目的 探讨肾透明细胞癌的CT表现与其病理分级之间的相关性,并建立病理分级预测数学模型.方法 94例肾透明癌的患者,均行泌尿系CT平扫+三期增强扫描,记录肿瘤大小、形态、有无假包膜、有无出血坏死,并分析其与术后病理结果的关系.采用 Fisher's法建立判别函数.结果 CT值均值、CT值标准差、CT值最大值、CT值中位数、肿瘤最大直径、肿瘤最小直径、肿瘤形状、有无包膜、有无血尿症状、有无腰痛症状与病理分级有关(P均＜0.05).多因素Logistic回归分析结果显示病理分级主要相关因素为肿瘤的最小直径、是否存在假包膜、CT值标准差.采用Fisher's法建立判别函数:y=0.172肿瘤最小直径+1.093包膜+0.015CT值均值+0.088CT值标准差+0.184规则- 2.929,判别标准y=0.30.本例样本判对率为77.7％,敏感度为74.1％,特异度为79.1％.结论 肾透明细胞癌的CT值、CT表现与其病理分级密切相关.其病理分级主要相关因素为肿瘤的最小直径、是否存在假包膜、CT值标准差.依据判别函数进行计算,若结果小于0.30,则肿瘤趋向高分化；若结果大于0.30,则肿瘤趋向低分化.