依据CT总碘摄取量预测胃癌新辅助化疗的反应
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摘要
目的:前瞻性评估双能量CT(dual-energy computed tomography, DECT)中的总碘摄取(total iodine uptake,TIU)在预测胃癌病人新辅助化疗疗效和无进展生存期(progression-free survival, PFS)的应用价值。方法:收集我院44例化疗前、后均行DECT扫描的局部进展期胃癌病人。计算肿瘤面积(%ΔS),直径(%ΔD)和密度(%ΔHU)的变化率来评估WHO、RESCIST和Choi标准。同时计算肿瘤体积(%ΔV)和门静脉期TIU的变化率(%ΔTIU-p)来评估ROC曲线下的界值。统计学分析不同标准与组织病理退缩分级(Becker)或PFS间的关系。结果:分别根据ΔV(43.34%,P=0.002)和ΔTIU-p(63.87%,P=0.002)的界值将病人分为反应组和非反应组。%ΔTIU-p标准与Becker间显示较强的相关性(r=0.602,P<0.001),%ΔV显示中等相关(r=0.416, P=0.005),而WHO(r=0.075, P=0.627), RECIST(r=0.270, P=0.077)和Choi标准(r=0.238, P=0.120)与Becker间无相关性。%ΔTIU-p(P=0.001)和Choi标准(P=0.013)的反应组和非反应组PFS间差异具有统计学意义。结论:TIU-p可预测进展期胃癌病人新辅助化疗后病理退缩。%ΔTIU-p分析新辅助化疗后的PFS有一定意义。
Objective To evaluate prospectively the total iodine uptake(TIU) from dual-energy computed tomography(DECT) in predicting treatment efficacy and progression-free survival(PFS) time in the patients with gastric cancers after neoadjuvant chemotherapy(NAC). Methods Forty-four patients with locally advanced gastric cancer were given DECT before and after NAC. Changes in percentage of tumor area(%ΔS), diameter(%ΔD), and density(%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. Changes in percentage of tumor volume(%ΔV) and TIU in portal phase(%ΔTIU-p) were also calculated to determine cut-off points by ROC curves. Correlations between criteria and histomorphologic tumor regression grade(Becker) and between criteria and PFS were analyzed. Results Patients were divided into responders group and non-responders group by ΔV(43.34%, P=0.002) and by ΔTIU-p(63.87%, P=0.002), respectively.Higher correlation was present between criteria %ΔTIU-p and Becker grade(r=0.602, P<0.001) and moderate correlation between criteria %ΔV and Becker grade(r=0.416, P=0.005), while no correlation between Becker grade and WHO criteria(r=0.075, P=0.627), RECIST criteria(r=0.270, P=0.077) and Choi criteria(r=0.238, P=0.120). There were statistical differences significantly in PFS time of the patients between responder group and non-responder group when using criteria%ΔTIU-p(P=0.001) or Choi criteria(P=0.013). Conclusions TIU-p could be used to predict pathological regression in patients with advanced gastric cancer after NAC. Criteria % ΔTIU-p would become the parameter to study PFS time after NAC.
Objective To evaluate prospectively the total iodine uptake(TIU) from dual-energy computed tomography(DECT) in predicting treatment efficacy and progression-free survival(PFS) time in the patients with gastric cancers after neoadjuvant chemotherapy(NAC). Methods Forty-four patients with locally advanced gastric cancer were given DECT before and after NAC. Changes in percentage of tumor area(%ΔS), diameter(%ΔD), and density(%ΔHU) were calculated to evaluate the WHO, RESCIST, and Choi criteria. Changes in percentage of tumor volume(%ΔV) and TIU in portal phase(%ΔTIU-p) were also calculated to determine cut-off points by ROC curves. Correlations between criteria and histomorphologic tumor regression grade(Becker) and between criteria and PFS were analyzed. Results Patients were divided into responders group and non-responders group by ΔV(43.34%, P=0.002) and by ΔTIU-p(63.87%, P=0.002), respectively.Higher correlation was present between criteria %ΔTIU-p and Becker grade(r=0.602, P<0.001) and moderate correlation between criteria %ΔV and Becker grade(r=0.416, P=0.005), while no correlation between Becker grade and WHO criteria(r=0.075, P=0.627), RECIST criteria(r=0.270, P=0.077) and Choi criteria(r=0.238, P=0.120). There were statistical differences significantly in PFS time of the patients between responder group and non-responder group when using criteria%ΔTIU-p(P=0.001) or Choi criteria(P=0.013). Conclusions TIU-p could be used to predict pathological regression in patients with advanced gastric cancer after NAC. Criteria % ΔTIU-p would become the parameter to study PFS time after NAC.
引文
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[17]Kiyabu M,Leichman L,Chandrasoma P.Effects of preoperative chemotherapy on gastric adenocarcinomas.Amorphologic study of 25 cases[J].Cancer,2015,70(9):2239-2245.
[18]Thian Y,Gutzeit A,Koh DM,et al.Revised Choi imaging criteria correlate with clinical outcomes in patients with metastatic renal cell carcinoma treated with sunitinib[J].Radiology,2014,273(2):452-461.
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[22]Tang L,Li ZY,Li ZW,et al.Evaluating the response of gastric carcinomas to neoadjuvant chemotherapy using iodine concentration on spectral CT:a comparison with pathological regression[J].Clin Radiol,2015,70(11):1198-1204.
[23]Park JO,Lee SI,Song SY,et al.Measuring response in solid tumors:comparison of RECIST and WHO response criteria[J].Jpn J Clin Oncol,2003,33(10):533-537.
[24]Ahn SH,Garewal HS,Dragovich T.Discrepancy in the assessment of tumor response in patients with pancreatic cancer:WHO versus RECIST criteria[J].J BUON,2008,13(3):359-362.
[25]Dai X,Schlemmer HP,Schmidt B,et al.Quantitative therapy response assessment by volumetric iodine-uptake measurement:initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib[J].Eur J Radiol,2013,82(2):327-334.
[26]Thian Y,Gutzeit A,Koh DM,et al.Revised Choi imaging criteria correlate with clinical outcomes in patients with metastatic renal cell carcinoma treated with sunitinib[J].Radiology,2014,273(2):452-461.
[27]Krajewski KM,Guo M,van den Abbeele AD,et al.Comparison of four early posttherapy imaging changes(EP-TIC;RECIST 1.0,tumor shrinkage,computed tomography tumor density,Choi criteria)in assessing outcome to vascular endothelial growth factor-targeted therapy in patients with advanced renal cell carcinoma[J].Eur Urol,2011,59(5):856-862.
[2]Ychou M,Boige V,Pignon JP,et al.Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma:an FNCLCC and FFCD multicenter phaseⅢtrial[J].J Clin Oncol,2011,29(13):1715-1721.
[3]Bichev D,Treese C,Winterfeld MV,et al.High impact of histopathological remission for prognosis after perioperative chemotherapy with ECF and ECF-Like regimens for gastric and gastroesophageal adenocarcinoma[J].Oncology,2015,89(2):95-102.
[4]Miller AB,Hoogstraten B,Staquet M,et al.Reporting results of cancer treatment[J].Cancer,1981,47(1):207-214.
[5]Watanabe H,Okada M,Kaji Y,et al.New response evaluation criteria in solid TUMORs:revised RECISTguideline(version 1.1)[J].Gan To Kagaku Ryoho,2009,36(13):2495-2501.
[6]Ott K,Fink U,Becker K,et al.Prediction of response to preoperative chemotherapy in gastric carcinoma by metabolic imaging:results of a prospective trial[J].J Clin Oncol,2003,21(24):4604-4610.
[7]Choi H.Response evaluation of gastrointestinal stromal tumors[J].Oncologist,2008,13 Suppl 2:4-7.
[8]Yang D,Woodard G,Zhou C,et al.Significance of different response evaluation criteria in predicting progression‐free survival of lung cancer with certain imaging characteristics[J].Thorac Cancer,2016,7(5):535-542.
[9]Liu K,Li G,Fan C,et al.Adapted Choi response criteria for prediction of clinical outcome in locally advanced gastric cancer patients following preoperative chemotherapy[J].Acta Radiol,2012,53(2):127-134.
[10]Stiller W,Skornitzke S,Fritz F,et al.Correlation of quantitative dual-energy computed tomography iodine maps and abdominal computed tomography perfusion measurements:are single-acquisition dual-energy computed tomography iodine maps more than a reduced-dose surrogate of conventional computed[J].Invest Radiol,2015,50(10):703-708.
[11]Apfaltrer P,Meyer M,Meier C,et al.Contrast-enhanced dual-energy CT of gastrointestinal stromal tumors:is iodine-related attenuation a potential indicator of tumor response?[J].Invest Radiol,2012,47(1):65-70.
[12]Uhrig M,Sedlmair M,Schlemmer HP,et al.Monitoring targeted therapy using dual-energy CT:semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases[J].Cancer Imaging,2013,13(3):306-313.
[13]Dai X,Schlemmer HP,Schmidt B,et al.Quantitative therapy response assessment by volumetric iodine-uptake measurement:initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib[J].Eur J Radiol,2013,82(2):327-334.
[14]Grady L.Random walks for image segmentation[J].IEEETrans Pattern Anal Mach Intell,2006,28(11):1768-1783.
[15]Becker K,Mueller JD,Schulmacher C,et al.Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy[J].Cancer,2003,98(7):1521-1530.
[16]Landis JR,Koch GG.The measurement of observer agreement for categorical data[J].Biometrics,1977,33(1):159-174.
[17]Kiyabu M,Leichman L,Chandrasoma P.Effects of preoperative chemotherapy on gastric adenocarcinomas.Amorphologic study of 25 cases[J].Cancer,2015,70(9):2239-2245.
[18]Thian Y,Gutzeit A,Koh DM,et al.Revised Choi imaging criteria correlate with clinical outcomes in patients with metastatic renal cell carcinoma treated with sunitinib[J].Radiology,2014,273(2):452-461.
[19]Lee SM,Kim SH,Lee JM,et al.Usefulness of CT volumetry for primary gastric lesions in predicting pathologic response to neoadjuvant chemotherapy in advanced gastric cancer[J].Abdom Imaging,2009,34(4):430-440.
[20]Benjamin RS,Choi H,Macapinlac HA,et al.We should desist using RECIST,at least in GIST[J].J Clin Oncol,2007,25(13):1760-1764.
[21]Motzer RJ,Michaelson MD,Redman BG,et al.Activity of SU11248,a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor,in patients with metastatic renal cell carcinoma[J].J Clin Oncol,2006,24(1):16-24.
[22]Tang L,Li ZY,Li ZW,et al.Evaluating the response of gastric carcinomas to neoadjuvant chemotherapy using iodine concentration on spectral CT:a comparison with pathological regression[J].Clin Radiol,2015,70(11):1198-1204.
[23]Park JO,Lee SI,Song SY,et al.Measuring response in solid tumors:comparison of RECIST and WHO response criteria[J].Jpn J Clin Oncol,2003,33(10):533-537.
[24]Ahn SH,Garewal HS,Dragovich T.Discrepancy in the assessment of tumor response in patients with pancreatic cancer:WHO versus RECIST criteria[J].J BUON,2008,13(3):359-362.
[25]Dai X,Schlemmer HP,Schmidt B,et al.Quantitative therapy response assessment by volumetric iodine-uptake measurement:initial experience in patients with advanced hepatocellular carcinoma treated with sorafenib[J].Eur J Radiol,2013,82(2):327-334.
[26]Thian Y,Gutzeit A,Koh DM,et al.Revised Choi imaging criteria correlate with clinical outcomes in patients with metastatic renal cell carcinoma treated with sunitinib[J].Radiology,2014,273(2):452-461.
[27]Krajewski KM,Guo M,van den Abbeele AD,et al.Comparison of four early posttherapy imaging changes(EP-TIC;RECIST 1.0,tumor shrinkage,computed tomography tumor density,Choi criteria)in assessing outcome to vascular endothelial growth factor-targeted therapy in patients with advanced renal cell carcinoma[J].Eur Urol,2011,59(5):856-862.
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