Immunotherapy response evaluation with magnetic resonance elastography (MRE) in advanced HCC
Immunotherapy response evaluation with magnetic resonance elastography (MRE) in advanced HCC
复制标题
磁共振弹性成像（MRE）评价晚期肝癌的免疫治疗反应
DOI：
10.1186/s40425-019-0766-y
复制
发表时间：
2019-11-28
影响因子：
10.9
通讯作者：
Kase, Ahmed O.
中科院分区：
文献类型：
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作者：
Qayyum, Aliya;Hwang, Ken-Pin;Kase, Ahmed O.
背景：目前，肝细胞癌（HCC）免疫治疗结果的影像学预测因子尚不明确。研究的目的是确定通过磁共振弹性成像（MRE）测量的硬度变化是否可以预测晚期HCC患者的免疫治疗反应。材料与方法本研究是一项前瞻性研究，15例经活检证实的晚期HCC患者接受Pembrolizumab治疗。所有患者在基线和治疗6周时均进行了肝脏MRE和肝脏活检。将MRE中HCC硬度的变化与总生存期（OS）、疾病进展时间（TTP）和肿瘤内CD 3 + T淋巴细胞数量进行比较。使用描述性统计和斯皮尔曼相关性（R）进行分析; p值< 0.05被认为具有统计学意义。结果9例患者可评价。中位年龄为71岁（范围：54-78岁）。肝病病因为HCV（n = 4）、HBV（n = 1）和NASH（n = 4）。中位OS和TTP分别为44周和13周。平均基线HCC硬度和HCC硬度变化分别为5.0 kPa和0.12 kPa。相比之下，平均非肿瘤肝硬度为3.2 kPa，在6周时没有显著变化（p = 0.42）。测量肿瘤的平均大小和大小变化分别为4cm和-0.32cm。6周时HCC硬度的变化与OS（R = 0.81）和TTP（R = 0.88，p < 0.01）显著相关。肿瘤活检中肿瘤内T淋巴细胞的减少与HCC硬度显著相关（R = 0.79，p = 0.007）。结论我们的初步MRE数据表明，肿瘤硬度的早期变化可能是晚期HCC患者免疫治疗反应的指标。
Background Currently, there are no imaging predictors of immunotherapy outcome in hepatocellular carcinoma (HCC). The study aim was to determine if stiffness changes measured by magnetic resonance elastography (MRE) can be a predictor of immunotherapy response in patients with advanced HCC. Materials and methods This was a prospective study of 15 patients with biopsy proven-advanced HCC treated with Pembrolizumab. All patients had liver MRE and liver biopsy at baseline and at 6 weeks of therapy. Change in HCC stiffness on MRE was compared with overall survival (OS), time to disease progression (TTP), and number of intratumoral CD3+ T lymphocytes. Analysis was performed using descriptive statistics and Spearman correlation (R); p-value < 0.05 was considered statistically significant. Results Nine patients were evaluable. Median age was 71 years (range, 54-78). Etiology of liver disease was HCV (n = 4), HBV (n = 1) and NASH (n = 4). Median OS and TTP were 44 weeks and 13 weeks, respectively. Average baseline HCC stiffness and change in HCC stiffness were 5.0 kPa and 0.12 kPa, respectively. In contrast, average non-tumor liver stiffness was 3.2 kPa, and did not significantly change at 6 weeks (p = 0.42). Average size of measured tumor and change in size were 4 cm and - 0.32 cm, respectively. Change in HCC stiffness at 6 weeks correlated significantly with OS (R = 0.81), and TTP (R = 0.88,p < 0.01). Abundance of intratumoral T lymphocytes on tumor biopsy correlated significantly with HCC stiffness (R = 0.79,p = 0.007). Conclusion Our pilot MRE data suggests early change in tumor stiffness may be an indicator of immunotherapy response in patients with advanced HCC.