鼻咽癌GTV分割中体积精度与解剖精度的影响：一项基于共识指南的研究
Impacts of volumetric vs. anatomical accuracies in GTV segmentation for nasopharyngeal carcinoma: a consensus-guideline-based study.
文献信息
| PMID | 42774145 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jiayang Lu |
| 作者单位 | Department of Radiotherapy, Cancer Hospital of Shantou University Medical College, Shantou University, Shantou, China. |
| 期刊 | Frontiers in medicine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 针对鼻咽癌（NPC）放疗的靶区分割共识指南已经发布，但既往研究在很大程度上忽视了此背景下的解剖精度。
方法： 纳入16例NPC患者。由三名放射肿瘤科医生和一名资深放射科医生独立勾画GTVnx和原发肿瘤预防性临床靶区（CTVp），以获得观察者分割（OSs）和参考GTVnx。根据参考GTVnx调整OS的原始CTVp。使用Dice相似系数（DSC）、第95百分位Hausdorff距离（HD95）和组内相关系数（ICC）评估CTVp一致性。通过精确度和真阳性率（TPR）、剂量学参数和肿瘤控制概率（TCP）评估体积精度和解剖精度的影响。
结果： 解剖精度显著较高（中位解剖TPR：89.5%-100%；精确度：80%-92%），体积精度则大幅较低（中位体积TPR：63.88%-73.92%；精确度：47.08%-70.29%）。原始CTVp与调整后CTVp之间的一致性差异微小（中位DSC：0.84 vs. 0.85，中位HD95：6.53 vs. 6.27 mm，ICC：0.98 vs. 0.99），两者均高于各OS间GTVnx的一致性（中位DSC：0.63，中位HD95：8.21 mm，ICC：0.92）。基于OS的治疗计划导致D95、EUD和TCP降低（D95、EUD和TCP平均降低：7.38 Gy、5.24 Gy和17.13%）。
结论： 在NPC中，原发肿瘤分割不准确主要是体积性的而非解剖性的。低体积精度可能降低TCP。在共识指南下，GTVnx分割的高解剖精度可能有助于实现一致的CTVp分割。
英文摘要
BACKGROUND: Consensus guidelines for target volume segmentation have been issued for nasopharyngeal carcinoma (NPC) radiotherapy, yet prior studies have largely overlooked anatomical accuracy in this context.
METHODS: Sixteen NPC patients were enrolled. GTVnx and prophylactic clinical target volume of primary tumor (CTVp) were independently contoured by three radiation oncologists and one senior radiologist to obtain observer segmentations (OSs) and reference GTVnx. Original CTVp of OS were adjusted according to reference GTVnx. CTVp consistency was evaluated with Dice Similarity Coefficient (DSC), 95th Hausdorff Distance (HD95) and Intraclass Correlation Coefficient (ICC). Impacts of volumetric and anatomical accuracy were evaluated with precision and true positive rate (TPR), dosimetric parameters and tumor control probability (TCP).
RESULTS: Anatomical accuracy was strikingly high (median anatomical TPR: 89.5%-100%; precision: 80%-92%), volumetric accuracy was substantially lower (median volumetric TPR: 63.88%-73.92%; precision: 47.08%-70.29%). Tiny differences were observed in CTVp consistency between original and adjusted CTVp (Median DSC: 0.84 vs. 0.85, Median HD95: 6.53 vs. 6.27 mm, ICC: 0.98 vs. 0.99), which were both higher than that of GTVnx consistency across OSs (Median DSC: 0.63, Median HD95: 8.21 mm, ICC: 0.92). Treatment plans based on OS resulted in decreased D95, EUD and TCP (average decrease of D95, EUD and TCP: 7.38 Gy, 5.24 Gy and 17.13%).
CONCLUSIONS: In NPC, primary tumor segmentation inaccuracies are predominantly volumetric rather than anatomical. Low volumetric accuracy may potentially reduce TCP. Under consensus guidelines, high anatomical accuracy in GTVnx segmentation may contribute to consistent CTVp segmentation.