影像学定量参数联合血清肿瘤标志物对胰腺导管腺癌术后预后的评估价值

冯宁宁; 张越山; 高涵; 杨宝明

doi:10.12449/JCH260620

影像学定量参数联合血清肿瘤标志物对胰腺导管腺癌术后预后的评估价值

DOI: 10.12449/JCH260620

河北医科大学第四医院肝胆外科，石家庄 050000

基金项目:

河北省医学科学研究课题 (20260565)

伦理学声明：本研究方案于2019年4月26日经由河北医科大学第四医院伦理委员会审批，批号：2019KY106。所纳入患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：冯宁宁负责课题设计，资料分析，撰写论文；张越山负责收集数据，修改论文；高涵、杨宝明负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
杨宝明， gdybm1983@163.com （ORCID： 0009-0006-9116-8547）

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出版历程
- 收稿日期: 2026-01-01
- 录用日期: 2026-02-26
- 出版日期: 2026-06-25

Value of quantitative imaging parameters combined with serum tumor markers in prognostic evaluation after pancreatic ductal adenocarcinoma surgery

Department of Hepatobiliary Surgery，Hebei Medical University Fourth Hospital，Shijiazhuang 050000，China

Research funding:

Medical Science Research Project of Hebei Province (20260565)

More Information

Corresponding author: YANG Baoming， gdybm1983@163.com （ORCID： 0009-0006-9116-8547）

摘要

摘要: 目的探讨影像学定量参数联合血清肿瘤标志物构建的预测模型在胰腺导管腺癌（PDAC）患者术后预后评估中的应用价值。方法回顾性选取2020年4月—2023年3月于河北医科大学第四医院接受根治性切除术治疗的146例PDAC患者为研究对象，采用完全随机法将患者按照7∶3的比例分为训练集（n=102）和验证集（n=44）。所有患者进行增强计算机体层成像（CT）以及多参数磁共振成像扫描，记录动脉期、静脉期和延迟期CT值以及b值为800 s/mm²的表观扩散系数（ADC）、T₂加权成像的信号强度（SI）；检测患者血清糖类抗原19-9（CA19-9）及癌胚抗原（CEA）水平。计量资料两组间比较采用成组t检验；计数资料两组间比较采用χ²检验。Kaplan-Meier法绘制生存曲线，生存情况的比较采用Log-rank检验；采用单因素及多因素Logistic分析评估各临床及影像学指标与预后的关系，并采用最小绝对值收敛和选择算子（LASSO）-Cox回归模型筛选影响患者预后的重要因素，构建预后预测模型。采用受试者操作特征曲线分析该模型在训练集和验证集中的预后预测价值。结果 Kaplan-Meier生存曲线分析显示，训练集患者的中位生存时间为33.00个月，验证集患者的中位生存时间为32.00个月，差异无统计学意义（P>0.05）。单因素分析结果显示，患者年龄、分化程度、淋巴结转移、肿瘤分期、血管侵犯、CA19-9、CEA、ADC及SI与患者生存预后有关（χ²值分别为5.906、13.116、12.807、17.277、14.611、7.275、14.339、9.506、13.137，P值均<0.05）。LASSO-Cox多因素回归分析显示，6个因素进入回归模型：肿瘤分期［风险比（HR）=8.934，95%CI：3.215～21.562，P<0.001］、淋巴结转移（HR=2.971，95%CI：1.298～5.647，P=0.002）、CA19-9（HR=3.948，95%CI：1.758～8.994，P<0.001）、CEA（HR=1.965，95%CI：1.083～3.664，P=0.039）、ADC（HR=2.873，95%CI：1.307～6.037，P=0.003）及SI（HR=3.107，95%CI：1.264～7.339，P=0.001）。基于上述指标构建的列线图模型在训练集中的预测曲线下面积为0.845［95%置信区间（CI）：0.774～0.915］，在验证集中的曲线下面积为0.919（95%CI：0.870～0.967）。结论基于LASSO-Cox回归构建的影像学定量参数-血清标志物联合模型可有效预测PDAC患者术后预后，有助于识别高风险患者，从而指导辅助治疗决策。
- 胰腺肿瘤 /
- 体层摄影术， X线计算机 /
- 多参数磁共振成像 /
- 生物标记，肿瘤 /
- 预后
Abstract: Objective To investigate the application value of a predictive model constructed based on quantitative imaging parameters and serum tumor markers in predicting the postoperative prognosis of patients with pancreatic ductal adenocarcinoma （PDAC）. Methods A retrospective study was conducted among 146 patients with PDAC who underwent radical resection in Hebei Medical University Fourth Hospital from April 2020 to March 2023， and the patients were divided into a training set with 102 patients and a validation set of 44 patients at a ratio of 7∶3 using the completely randomized method. All patients underwent enhanced computed tomography （CT） and multi-parametric magnetic resonance imaging scans， and CT values in the arterial phase， the venous phase， and the delayed phase were recorded， as well as apparent diffusion coefficient （ADC） at b = 800 s/mm² and signal intensity （SI） of T₂ weighted imaging. The serum levels of carbohydrate antigen 19-9 （CA19-9） and carcinoembryonic antigen （CEA） were also measured. The independent-samples t test was used for comparison of continuous data between groups， and the chi-square test was used for comparison of categorical data between groups. Kaplan-Meier survival curves were plotted for survival analysis； the univariate and multivariate Logistic regression analysis was used to investigate the association of clinical and imaging indicators with prognosis； the least absolute shrinkage and selection operator （LASSO）-Cox regression model was used to identify the important influencing factors for prognosis， and a prognostic prediction model was constructed. The receiver operating characteristic （ROC） curve was used to analyze the predictive value of the model in predicting prognosis in both the training set and the validation set. Results The Kaplan-Meier survival curve analysis showed a median survival time of 33.00 months in the training set and 32.00 months in the validation set， with no significant difference between the training set and the validation set （P>0.05）. The univariate analysis showed that patient age， degree of tumor differentiation， lymph node metastasis， tumor stage， vascular invasion， CA19-9， CEA， ADC value， and SI value were significantly associated with the survival prognosis of patients （χ²=5.906， 13.116， 12.807， 17.277， 14.611， 7.275， 14.339， 9.506， and 13.137， all P<0.05）. The LASSO-Cox multivariate regression analysis showed that six factors were incorporated into the regression model， i.e.， tumor stage （HR=8.934， 95%CI： 3.215 — 21.562， P<0.001）， lymph node metastasis （HR=2.971， 95%CI： 1.298 — 5.647， P=0.002）， CA19-9 （HR=3.948， 95%CI： 1.758 — 8.994， P<0.001）， CEA （HR=1.965， 95%CI： 1.083 — 3.664， P=0.039）， ADC value （HR=2.873， 95%CI： 1.307 — 6.037， P=0.003）， and SI value （HR=3.107， 95%CI： 1.264 — 7.339， P=0.001）. The nomogram model constructed based on these factors had an area under the ROC curve of 0.845 （95%CI： 0.774 — 0.915） in the training set and 0.919 （95%CI： 0.870 — 0.967） in the validation set. Conclusion The combined model of quantitative imaging parameters and serum tumor markers constructed based on LASSO-Cox regression can effectively predict the postoperative prognosis of PDAC patients， thereby helping to identify high-risk patients and guide decision-making for adjuvant therapy.
- Pancreatic Neoplasms /
- Tomography， X-Ray Computed /
- Multiparametric Magnetic Resonance Imaging /
- Biomarkers， Tumor /
- Prognosis

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图 1 训练集患者生存曲线

Figure 1. Survival curve of patients in the training set

下载: 全尺寸图片幻灯片

图 2 验证集患者生存曲线

Figure 2. Survival curve of patients in the validation set

下载: 全尺寸图片幻灯片

注： a，交叉验证曲线；b，系数路径图。

图 3 胰腺导管腺癌术后预后最小绝对值收敛和选择算子回归变量筛选

Figure 3. The minimum absolute contraction and selection operator regression variable screening for prognosis after pancreatic ductal carcinoma surgery

下载: 全尺寸图片幻灯片

注： CA19-9，糖类抗原19-9；CEA，癌胚抗原；ADC，表观扩散系数；SI，信号强度。

图 4 胰腺导管腺癌术后预后预测列线图模型

Figure 4. Nomogram model for predicting prognosis after pancreatic ductal adenocarcinoma surgery

下载: 全尺寸图片幻灯片

注： a，训练集；b，验证集。

图 5 模型对训练集和验证集患者预后预测价值的受试者操作特征曲线分析

Figure 5. ROC curve analysis of the model to evaluate its predictive value for the prognosis of patients in the training set and patients in the validation set

下载: 全尺寸图片幻灯片

表 1 训练集及验证集患者临床资料比较

Table 1. Comparison of clinical data of patients in the training set and the validation set

临床资料	训练集（n=102）	验证集（n=44）	统计值	P值
性别［例（%）］			χ²=0.186	0.666
男	48（47.06）	19（43.18）
女	54（52.94）	25（56.82）
年龄（岁）	55.23±8.64	54.58±6.59	t=0.446	0.656
高血压［例（%）］	25（24.51）	13（29.55）	χ²=0.405	0.525
糖尿病［例（%）］	17（16.67）	6（13.64）	χ²=0.213	0.645
分化程度［例（%）］			χ²=0.251	0.617
中高分化	67（65.69）	27（61.36）
低分化	35（34.31）	17（38.64）
肿瘤最大径（cm）	3.57±1.21	3.74±1.30	t=0.762	0.448
肿瘤位置［例（%）］			χ²=0.059	0.812
胰头颈部	67（65.69）	28（63.64）
胰体尾部	35（34.31）	16（36.36）
淋巴结转移［例（%）］	39（38.24）	15（34.09）	χ²=0.227	0.634
肿瘤分期［例（%）］			χ²=0.133	0.715
Ⅰ期	38（37.25）	15（34.09）
Ⅱ～Ⅲ期	64（62.75）	29（65.91）
血管侵犯［例（%）］	41（40.20）	17（38.64）	χ²=0.031	0.860
CA19-9（U/mL）	185.43±53.02	189.28±31.64	t=0.448	0.655
CEA（U/mL）	12.56±4.21	13.04±3.15	t=0.678	0.499
CT值（HU）
平扫期	34.83±3.19	36.04±3.95	t=1.953	0.053
动脉期	43.87±5.52	41.96±6.03	t=1.865	0.064
门静脉期	54.58±7.93	54.02±8.49	t=0.383	0.702
延迟期	60.21±5.68	59.38±6.10	t=0.792	0.430
ADC（×10^-3 mm²/s）	1.21±0.31	1.27±0.28	t=1.104	0.272
SI（×10^-3）	0.45±0.09	0.46±0.12	t=0.555	0.580
注：CA19-9，糖类抗原19-9；CEA，癌胚抗原；CT，计算机断层扫描；ADC，表观扩散系数；SI，信号强度。

下载: 导出CSV

表 2 训练集患者生存预后单因素分析

Table 2. Univariate analysis of survival prognosis of patients in the training set

因素	例数	中位生存期（月）	95%CI	χ²值	P值
性别				0.159	0.690
男	48	34.00	27.512～40.488
女	54	32.00	22.398～41.602
年龄				5.906	0.015
≥55岁	53	28.00	22.650～33.350
<55岁	49	38.00	34.193～41.807
高血压	25	32.00	23.840～40.160	0.438	0.508
糖尿病	17	31.00	18.899～43.101	0.823	0.364
分化程度				13.116	<0.001
中高分化	67	38.00	35.669～40.331
低分化	35	23.00	14.443～31.557
肿瘤最大径				0.233	0.629
≥3.5 cm	55	34.00	28.627～39.373
<3.5 cm	47	28.00	14.806～41.194
肿瘤位置				0.273	0.602
胰头颈部	67	34.00	28.092～39.908
胰体尾部	35	33.00	22.706～43.294
淋巴结转移	39	24.00	16.658～31.342	12.807	<0.001
肿瘤分期				17.277	<0.001
Ⅰ期	38	43.00	34.006～51.994
Ⅱ～Ⅲ期	64	28.00	23.569～32.431
血管侵犯	41	25.00	19.772～30.228	14.611	<0.001
CA19-9				7.275	0.007
≥185 U/mL	56	26.00	19.714～32.286
<185 U/mL	46	39.00	33.412～44.588
CEA				14.339	0.001
≥12 U/mL	54	24.00	17.827～30.173
<12 U/mL	48	40.00	37.408～42.592
平扫期CT值				1.170	0.279
≥34 HU	59	32.00	23.577～40.423
<34 HU	43	35.00	29.493～40.507
动脉期CT值				0.830	0.362
≥43 HU	61	36.00	30.265～41.735
<43 HU	41	29.00	20.934～37.066
门静脉期CT值				0.072	0.788
≥54 HU	63	34.00	28.920～39.080
<54 HU	39	32.00	21.115～42.885
延迟期CT值				0.802	0.370
≥60 HU	57	37.00	26.994～47.006
<60 HU	45	32.00	26.840～37.160
ADC				9.506	0.002
≥1.2×10^-3 mm²/s	60	38.00	35.501～40.499
<1.2×10^-3 mm²/s	42	27.00	20.649～33.351
SI				13.137	0.001
≥0.45×10^-3	58	26.00	19.506～32.494
<0.45×10^-3	44	39.00	35.856～42.144
注：CA19-9，糖类抗原19-9；CEA，癌胚抗原；CT，计算机体层成像；ADC，表观扩散系数；SI，信号强度；CI，置信区间。

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表 3 胰腺导管腺癌术后预后Cox多因素回归分析

Table 3. Cox multivariate regression analysis of prognosis after pancreatic ductal adenocarcinoma surgery

因素	HR	95%CI	P值
肿瘤分期	8.934	3.215～21.562	<0.001
淋巴结转移	2.971	1.298～5.647	0.002
CA19-9	3.948	1.758～8.994	<0.001
CEA	1.965	1.083～3.664	0.039
ADC	2.873	1.307～6.037	0.003
SI	3.107	1.264～7.339	0.001
注：CA19-9，糖类抗原19-9；CEA，癌胚抗原；ADC，表观扩散系数；SI，信号强度；HR，风险比；CI，置信区间。

下载: 导出CSV

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