Unresectable Hepatocellular Carcinoma: MR Imaging after Intraarterial Therapy. Part II. Response Stratification Using Volumetric Functional Criteria after Intraarterial Therapy
Unresectable Hepatocellular Carcinoma: MR Imaging after Intraarterial Therapy. Part II. Response Stratification Using Volumetric Functional Criteria after Intraarterial Therapy
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DOI：
10.1148/radiol.13121637
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发表时间：
2013-08-01
期刊：
影响因子：
19.7
通讯作者：
Kamel, Ihab R.
中科院分区：
文献类型：
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作者：
Bonekamp, Susanne;Halappa, Vivek Gowdra;Kamel, Ihab R.
目的：评估初次动脉内治疗后 3-4 周的体积功能磁共振 (MR) 结果是否有助于准确区分有反应者和无反应者，确定总生存期 (OS) 是否得到改善，并将体积功能 MR 反应与解剖学反应标准（实体瘤反应评估标准 [RECIST]、改良 RECIST [mRECIST]、欧洲肝脏研究协会 [EASL]）以及α(1)-胎蛋白 [AFP] 水平。 材料和方法：在这项符合 HIPAA 的单一机构回顾性、机构审查委员会批准的研究中，放弃了知情同意书； 2005 年 10 月至 2011 年 2 月期间，143 名肝细胞癌患者接受了动脉内治疗。体积功能 MR 反应（表观弥散系数增加 25% 或更多，增强减少 65% 或更多）分层如下：双参数反应者满足两项标准，单参数反应者满足一项标准，而疾病稳定 (SD) 者则不满足任何一项标准。确定了 RECIST、mRECIST、EASL 和 AFP 反应标准。使用 Kaplan-Meier 技术、对数秩检验和 Cox 比例风险模型来测试每次响应的 OS 是否不同。结果：单参数响应者和双参数响应者之间 (P = .01) 以及单参数响应者和 SD 响应者之间 (P = .001) OS 存在显着差异。与单参数应答者相比，双参数应答者的反应改善了 OS；死亡风险降低（风险比 [HR] = 0.28，P = .01）。与单参数反应者相比，SD 患者的死亡风险增加（HR = 2.09，P = .001）。 RECIST、mRECIST 和 EASL 分层不显着；大多数病变被分类为SD。 55 名患者的基线 AFP 水平升高； AFP 应答者与 AFP 无应答者相比，死亡风险降低（HR = 0.36，P = .002）。解剖学反应标准与体积功能 MR 结果（kappa = 0.06-0.12）之间以及 AFP 反应与成像标准（kappa = -0.04 至 0.14）之间的一致性较低。结论：初始动脉内治疗后 3-4 周的体积功能 MR 反应显示 OS 有所改善。体积功能 MR 优于当前的影像学（RECIST、mRECIST 和 EASL）和生化（AFP 水平）反应标准。 （右）北美放射学会，2013
Purpose: To assess whether volumetric functional magnetic resonance (MR) results 3-4 weeks after initial intraarterial therapy can aid accurate distinction between responders and nonresponders, to determine whether overall survival (OS) is improved, and to compare volumetric functional MR response with anatomic response criteria (Response Evaluation Criteria in Solid Tumors [RECIST], modified RECIST [mRECIST], European Association for the Study of the Liver [EASL]), as well as alpha(1)-fetoprotein [AFP] level.Materials and Methods: In this single-institution HIPAA-compliant retrospective, institutional review board-approved study, informed consent was waived; 143 patients with hepatocellular carcinoma underwent intraarterial therapy between October 2005 and February 2011. Volumetric functional MR response (25% or more increase in apparent diffusion coefficient, 65% or more decrease in enhancement) was stratified as follows: Dual-parameter responders fulfilled both criteria, single-parameter responders fulfilled one criterion, and those with stable disease (SD) fulfilled neither. RECIST, mRECIST, EASL, and AFP response criteria were determined. Kaplan-Meier technique, log-rank tests, and the Cox proportional hazards model were used to test whether OS was different per response.Results: OS differed significantly between single-parameter responders and dual-parameter responders (P = .01) and between single-parameter responders and those with SD (P = .001). Dual-parameter responders' response improved OS compared with single-parameter responders; risk of death decreased (hazard ratio [HR] = 0.28, P = .01). In those with SD compared with single-parameter responders, risk of death increased (HR = 2.09, P = .001). RECIST, mRECIST, and EASL stratification was short of significant; most lesions were classified as SD. Baseline AFP level increased in 55 patients; AFP responders versus AFP nonresponders had decreased risk of death (HR = 0.36, P = .002). Agreement between anatomic response criteria and volumetric functional MR findings (kappa = 0.06-0.12) and between AFP response and imaging criteria (kappa = -0.04 to 0.14) was low.Conclusion: Volumetric functional MR response 3-4 weeks after initial intraarterial therapy showed improved OS. Volumetric functional MR was superior to current imaging (RECIST, mRECIST, and EASL) and biochemical (AFP level) response criteria. (R) RSNA, 2013