| Objective:To explore the application value of ADC value generated based on DWI in early evaluation of chemotherapy efficacy of Tibetan patients with advanced gastric cancer,in order to assist clinicians to understand the patients'chemotherapy efficacy early,adjust treatment strategies in time,and make personalized treatment plans for patients.Methods:As a prospective study,it has been approved by our hospital'ethics committee?ethical review number ME-TBHP-19-18?.According to the inclusion and exclusion criteria,the Tibetan patients diagnosed with advanced gastric cancer through clinical pathology who were admitted to the Oncology Department of Tibetan Autonomous Region People's Hospital from October 2018 to February 2020 were taken as the research objects.All patients signed the informed consent,the degree of gastric cancer differentiation and Ki-67 index of pathological immunohistochemistry before chemotherapy were recorded.Each patient underwent routine MRI scan+DWI within one week before the first chemotherapy,one week after the first cycle of chemotherapy,and one week after 2-3 cycles of chemotherapy.All MRI images were evaluated by three experienced radiologists whether the image quality met the research requirements,and the three doctors negotiated to determine the tumor size and ADC measurement results.The ADC value?including the minimum of three measurements and the average of three measurements?and the size of the cancer?including the thick diameter and long diameter?in the image of each examination were recorded.Based on different chemotherapy regimens,the efficacy evaluation was performed according to RECIST 1.1 after 2 or 3 cycles of chemotherapy,and the subjects were divided into the effective group?CR+PR?and the ineffective group?SD+PD?based on the results of the efficacy evaluation.Statistical analysis was performed using SPSS19.0 software package.Results:?The values of ADCmin0and ADCave0before the first chemotherapy in the effective group were?0.906±0.068?×10-3mm2/s,the first chemotherapy in the ineffective group were?0.994±0.084?×10-3 difference in ADCave0between the two groups were statistically significant?P<0.05?.After 1 cycle of chemotherapy,the differences in ADCmin1and ADCave1values between the effective and ineffective groups were statistically significant?P<0.05?,but there were no significant differences in ADCmin2and ADCave2values between the two groups after2-3 cycles of chemotherapy?P>0.05?.There were statistically significant differences between the two groups in the amount and rate of change in ADCminafter 1 cycle of chemotherapy,the amount and rate of change in ADCminafter 2-3 cycles of chemotherapy,and the amount and rate of change in ADCaveafter 2-3 cycles of chemotherapy?P<0.05?.But there was no significant difference in the amount and rate of change in ADCaveafter 1 cycle of chemotherapy?P>0.05?.?Using the ROC curve to analyze the ADC value(ADCmin0,ADCave0)before the first chemotherapy of the gastric cancer lesions showed that the area under the curve was 0.813 Vs 0.796,take the best threshold of 0.938 Vs 1.002,the sensitivity of ADCmin0and ADCave0to predict the efficacy of advanced gastric cancer chemotherapy was 0.828Vs 0.793,and the specificity 0.818 Vs 0.727.The ROC curve analysis of the amount and rate of change in ADCminafter 1 cycle of chemotherapy for gastric cancer lesions showed that the area under the curve was 0.751Vs 0.809,take the best threshold of 0.079 Vs 8.539,the ADCmin1-0and?1ADCminvalues after 1 cycle of chemotherapy had a sensitivity of 0.727Vs 0.727 and a specificity of 0.724 Vs 0.828 in evaluating the efficacy of chemotherapy for advanced gastric cancer.?There was no significant difference in lesion size between the effective and ineffective groups before the first chemotherapy and after 1cycle of chemotherapy?P>0.05?.After 2-3 cycles of chemotherapy,the tumor shrinkage rate of the largest diameter??thickness,?length?was significantly different between the two groups?P<0.05?.?The amount and rate of change in ADCminafter 1 cycle of chemotherapy were positively correlated with the tumor shrinkage rate of the largest diameter??thickness,?length?after 2-3 cycles of chemotherapy?P<0.01?.The rate of change in ADCaveafter 1 cycle of chemotherapy had a low positive correlation with the tumor thickness shrinkage rate??thickness?after 2-3 cycles of chemotherapy?P<0.05?.?The degree of differentiation of gastric cancer was moderately positively correlated with the ADCmin0and ADCave0values before the first chemotherapy?P<0.01?.?The correlation analysis of Ki-67 expression with ADCmin0and ADCave0values in patients with advanced gastric cancer before the first chemotherapy was not statistically significant?P>0.05?.Conclusion:?The ADCminvalue and ADCavevalue before the first chemotherapy in the effective group were lower than those in the ineffective group,and after chemotherapy,the change rate of ADC value in the effective group was higher than that in the ineffective group.?There was a correlation between the amount/rate of the change of ADCminvalue after 1 cycle of chemotherapy and the tumor maximum shrinkage rate??thickness,?length?after 2-3 cycles of chemotherapy.By measuring the change in ADCminvalue before and after 1 cycle of chemotherapy,it can help to understand the efficacy of chemotherapy in patients with advanced gastric cancer at an early stage,in order to guide clinical treatment.?ADCminwas more accurate and sensitive than ADCavein predicting the efficacy of chemotherapy for advanced gastric cancer in the early stage.?The lower the degree of gastric cancer differentiation,the lower its ADC value. |
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