Assessing Tumor Response and Detecting Recurrence in Metastatic Renal Cell Carcinoma on Targeted Therapy: Importance of Size and Attenuation on Contrast-Enhanced CT
Assessing Tumor Response and Detecting Recurrence in Metastatic Renal Cell Carcinoma on Targeted Therapy: Importance of Size and Attenuation on Contrast-Enhanced CT
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DOI：
10.2214/ajr.09.2941
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发表时间：
2010-01-01
影响因子：
5
通讯作者：
Shah, Shetal N.
中科院分区：
文献类型：
--
作者：
Smith, Andrew Dennis;Lieber, Michael L.;Shah, Shetal N.
目标。本研究的目的是通过评估肿瘤大小和衰减的变化以及检测对比增强CT （CECT）上独特的对比增强模式来改善转移性肾细胞癌（RCC）患者对抗血管生成靶向治疗的反应评估。材料和方法。53例接受一线索拉非尼或舒尼替尼治疗的转移性透明细胞RCC患者的肿瘤长轴测量和靶病变在CECT图像上的体积平均肿瘤衰减与进展时间相关。评估特定肿瘤进展模式的频率。这些数据被用于制定新的成像标准，即大小和衰减CT （SACT）标准。采用SACT标准、实体瘤反应评价标准（RECIST）和改良Choi标准对CECT结果进行评估，并使用Kaplan-Meier法估计生存功能。在开始靶向治疗后无进展生存期为> 250天（n = 44）的59%的患者中，一个或多个目标转移灶的bb0 = 40 HU衰减降低；0%的早期疾病进展患者（n = 9）有这一发现。基于SACT标准的良好反应在识别无进展生存期为250天的患者方面具有75%的敏感性和100%的特异性，而RECIST标准分别为16%和100%，改良Choi标准分别为93%和44%。在转移性RCC开始靶向治疗后，在第一次CECT研究中客观地测量肿瘤大小和衰减的变化，显著提高了疗效评估。在靶向治疗的转移性RCC患者中可以看到不同的疾病复发模式。
OBJECTIVE. The aim of this study was to improve response assessment in patients with metastatic renal cell carcinoma (RCC) on antiangiogenic targeted therapy by evaluating changes in both tumor size and attenuation and by detecting unique patterns of contrast enhancement on contrast-enhanced CT (CECT).MATERIALS AND METHODS. Tumor long-axis measurements and volumetric mean tumor attenuation of target lesions on CECT images were correlated with time to progression in 53 patients with metastatic clear cell RCC treated with first-line sorafenib or sunitinib. The frequencies of specific patterns of tumor progression were assessed. The data were used to develop new imaging criteria, the size and attenuation CT (SACT) criteria. CECT findings were evaluated using the SACT criteria, Response Evaluation Criteria in Solid Tumors (RECIST), and modified Choi criteria, and the Kaplan-Meier method was used to estimate survival functions.RESULTS. One or more target metastatic lesions had decreased attenuation of >= 40 HU in 59% of patients with progression-free survival of > 250 days (n = 44) after initiating targeted therapy; 0% of patients with earlier disease progression (n = 9) had this finding. A favorable response based on SACT criteria had a sensitivity of 75% and specificity of 100% for identifying patients with progression-free survival of > 250 days, versus 16% and 100%, respectively, for RECIST and 93% and 44% for the modified Choi criteria.CONCLUSION. Objectively measuring changes in both tumor size and attenuation on the first CECT study after initiating targeted therapy for metastatic RCC markedly improves response assessment. Distinct patterns of disease recurrence are seen in patients with metastatic RCC on targeted therapy.