Perfusion CT in Patients With Metastatic Renal Cell Carcinoma Treated With Interferon
Perfusion CT in Patients With Metastatic Renal Cell Carcinoma Treated With Interferon
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DOI：
10.2214/ajr.09.3105
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发表时间：
2010-01-01
影响因子：
5
通讯作者：
Tannir, Nizar M.
中科院分区：
文献类型：
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作者：
Ng, Chaan S.;Wang, Xiaohong;Tannir, Nizar M.
OBJECTIVE.我们研究的目的是评估通过灌注CT测量的肿瘤灌注参数作为可能的预后生物标志物和干扰素治疗转移性常规肾细胞癌（RCC）患者治疗效果的早期指标的潜在价值。这项研究包括37例转移性RCC患者，他们参加了一项更大的（n = 118）中低剂量干扰素的随机临床试验。肿瘤灌注参数，即肿瘤血流量，血容量，平均通过时间（MTT），和指数转移病灶的渗透性表面积产品，在基线和8周的随访。比较基线灌注参数和随访时的变化，并估计其与患者无进展生存期的相关性。进行单变量和多变量分析。28例患者可评估。中位无进展生存期为5.3个月（95% CI，2.4-7.4个月），有1例部分缓解。在单变量（风险比[HR] = 1.006，p = 0.025）和多变量（HR = 1.007，p = 0.012）分析中，基线时肿瘤血流量与患者无进展生存期呈负相关。与基线扫描相比，随访扫描中肿瘤血流量显著增加，MTT显著降低（均为p = 0.04），但未检测到灌注参数变化与无进展生存期之间的相关性。高基线肿瘤血流量所示的高度血管化转移性RCC患者的预后似乎比那些没有血管化的患者更差。肿瘤灌注可能是一个有用的预后生物标志物，此外，在未来，可能有助于治疗分层。由于干扰素在转移性肾细胞癌中的抗血管生成活性有限，本研究中可能未充分评估灌注CT作为早期反应指标的潜在效用。
OBJECTIVE. The objective of our study was to assess the potential value of tumor perfusion parameters measured by perfusion CT as possible biomarkers of prognosis and early indicator of treatment efficacy in patients with metastatic conventional renal cell carcinoma (RCC) treated with interferon.MATERIALS AND METHODS. This study comprised 37 patients with metastatic RCC who were enrolled in a larger (n = 118) randomized clinical trial of intermediate-versus low-dose interferon. Tumor perfusion parameters-that is, tumor blood flow, blood volume, mean transit time (MTT), and permeability-surface area product-of index metastatic lesions were obtained at baseline and at 8-week follow-up. Baseline perfusion parameters and changes at follow-up were compared, and their associations with patient progression-free survival were estimated. Univariate and multivariate analyses were performed.RESULTS. Twenty-eight patients were assessable. Median progression-free survival was 5.3 months (95% CI, 2.4-7.4 months), with one partial response. Tumor blood flow at baseline was inversely associated with patient progression-free survival in both univariate (hazard ratio [HR] = 1.006, p = 0.025) and multivariate (HR = 1.007, p = 0.012) analyses. There were significant increases in tumor blood flow and reductions in MTT on follow-up scans compared with baseline scans (both, p = 0.04), but no association between changes in perfusion parameters and progression-free survival was detected.CONCLUSION. Patients with highly vascularized metastatic RCC as shown by high baseline tumor blood flow appear to have a worse prognosis than those who do not. Tumor perfusion may be a useful biomarker of prognosis and additionally, in the future, may assist in treatment stratification. The potential utility of perfusion CT as an early response indicator was probably inadequately assessed in this study because of the limited antiangiogenic activity of interferon in metastatic RCC.