Vascular Tumor Burden as a New Quantitative CT Biomarker for Predicting Metastatic RC Response to Antiangiogenic Therapy
Vascular Tumor Burden as a New Quantitative CT Biomarker for Predicting Metastatic RC Response to Antiangiogenic Therapy
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DOI：
10.1148/radiol.2016160143
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发表时间：
2016-11-01
期刊：
影响因子：
19.7
通讯作者：
Griswold, Michael
中科院分区：
文献类型：
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作者：
Smith, Andrew D.;Zhang, Xu;Griswold, Michael
目的：量化血管肿瘤负荷 (VTB) 的初始变化，VTB 是计算机断层扫描 (CT) 图像上血管化肿瘤面积的衡量标准，并预测转移性肾细胞癌 (RCC) 患者对抗血管生成治疗的肿瘤反应。 材料和方法：对于这项机构审查委员会批准的符合 HIPAA 的前瞻性 III 期试验二次分析，纳入了接受舒尼替尼治疗的具有数字 CT 图像和转移性透明细胞 RCC 的成年患者 (n = 275）。采用实体瘤疗效评估标准（RECIST）1.1指南选择靶病灶，将舒尼替尼治疗一个周期后获得的CT图像与基线图像进行比较进行评估。肿瘤反应软件的创建是为了量化肿瘤指标（长度、面积、VTB 和平均衰减）并自动进行反应评估。根据 VTB 标准，使用 Cox 比例风险比 (HR) 比较有反应者和无反应者的无进展生存期 (PFS)。使用组内相关系数 (ICC) 来评估评估 28 名随机选择的患者的三位读者之间的观察者间一致性。结果：根据初始治疗后 CT 研究，VTB 标准无反应者 (n = 120) 经历疾病进展的可能性高出 5.7 倍（HR = 5.70；95% 置信区间 [CI]：4.07, 7.97；P
Purpose: To quantify initial changes in the vascular tumor burden (VTB), a measure of the area of vascularized tumor on computed tomographic (CT) images, and predict tumor response to antiangiogenic therapy in patients with metastatic renal cell carcinoma (RCC).Materials and Methods: For this institutional review board-approved HIPAA-compliant secondary analysis of a prospective phase III trial, adult patients with digital CT images and metastatic clear-cell RCC treated with sunitinib were included (n = 275). Target lesions were selected by using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines, and the CT images obtained after one cycle of sunitinib therapy were evaluated in comparison with baseline images. Tumor-response software was created to quantify tumor metrics (length, area, VTB, and mean attenuation) and automate response assessment. Progression-free survival (PFS) in responders and nonresponders according to VTB criteria was compared by using the Cox proportional hazard ratio (HR). The intraclass correlation coefficient (ICC) was used to assess interobserver agreement among three readers evaluating 28 randomly selected patients.Results: VTB criteria nonresponders (n = 120) according to the initial posttherapy CT study were 5.7 times more likely to experience progression of disease (HR = 5.70; 95% confidence interval [CI]: 4.07, 7.97; P