基于CT功能成像的胃癌新辅助化疗疗效的早期评价研究

Neoadjuvant chemotherapy can increase the resection rate and survival time of patients with advanced gastric cancer,However, neoadjuvant chemotherapy efficacy evaluation of gastric cancer has still lack of uniform standards until today, objective and accurate preoperative effect assessment is very important for further treatment options and prognosis. In this study, we use CT spectroscopy imaging technology to improve the accuracy of preoperative staging by selecting the best single-energy image of the lesions, and comparative analyse CT energy spectrum diagram (scatter plots, histograms) and spectrum curve in the different efficacy patients with chemotherapy before and after chemotherapy, according to the attenuation curve and the measurement of the base material qualitative and quantitative to evaluate of the efficacy of gastric cancer neoadjuvant chemotherapy; Use dual-source CT perfusion imaging technology by measuring the changes of tumor perfusion parameters before and after chemotherapy to determine tumor blood essels physiological and pathological features, evaluate the value of CT perfusion functional imaging techniques in the early efficacy monitoring in gastric cancer neoadjuvant chemotherapy; Application cDNA expression microarray screening and identification of the different efficacy before chemotherapy group and tumor tissue differentially expressed genes in order to a diagnostic model to predict the efficacy and resistance to chemotherapy of gastric cancer, so as to guide clinical personalized medicine, improve curative effect.

新辅助化疗可以提高进展期胃癌患者的手术切除率及生存时间，但至今缺乏统一的疗效评价标准。针对现状，本研究①利用宝石CT能谱成像技术通过选择显示病灶的最佳单能量图像，提高术前分期准确率，并对比分析不同疗效患者化疗前后的CT能谱分析图及能谱曲线，根据衰减曲线和基物质的测量定性、定量地评价胃癌新辅助化疗的疗效；②利用CT灌注成像技术通过测量化疗前后肿瘤组织灌注参数变化来判断肿瘤血管的生理、病理特征，评价CT灌注功能成像技术在胃癌新辅助化疗早期疗效监测中的应用价值；③利用基因芯片技术根据病理疗效评价标准对化疗敏感肿瘤和耐药肿瘤治疗前标本的基因表达谱进行分析、筛选、确定，并与CT量化参数指标相结合，建立一个预测疗效的诊断模型，再用该模型对新的患者进行预测以检验其准确性。本研究的最终结果将有望于指导患者选择最适宜的化疗组合方案，实现临床的个体化治疗，避免盲目用药，提高疗效。

新辅助化疗可以提高进展期胃癌患者的手术切除率及生存时间，但至今缺乏统一的疗效评价标准。针对现状，木研究①利用CT能谱成像技术通过选择显示病灶的最佳单能量图像，提高术前分期准确率，并对比分析不同疗效患者化疗前后的CT能谱分析图及能谱曲线，根据衰减曲线和基物质的测量定性、定量地评价胃癌新辅助化疗的疗效；②利用CT灌注成像技术通过测量化疗前后肿瘤组织灌注参数变化来判断肿瘤血管的生理、病理特征，评价CT灌注功能成像技术在胃癌新辅助化疗早期疗效监测中的应用价值。本研究的最终结果将有望于指导患者选择最适宜的化疗组合方案，实现临床的个体化治疗，避免盲目用药，提高疗效。本项目始终按计划展开工作，执行的结果主要反映在获得资助的2项国家级及6项省部级课题，出版的10本著作，发表的25篇论文，其中SCI收录7篇，申请成功的国家级专利1项，已培养硕士研究生6名，博士研究生3名，参加的12场国内学术会议及5场RSNA或ECR会议中。